Collaborating for Better Atopic Dermatitis (AD) Care: How Primary Care and Dermatology Can Work Together
Roles and Responsibilities
- Primary Care Physicians (PCPs): Initial diagnosis, management of mild-to-moderate disease, coordination of care, holistic patient monitoring
- Dermatologists: Management of severe/recalcitrant cases, specialized testing, initiation of advanced therapies, procedural interventions
- Shared Responsibilities: Patient education, comorbidity identification, trigger avoidance strategies, treatment adherence support
Optimal Referral Pathway
- Referral Criteria:
- Diagnostic uncertainty
- Inadequate response to optimized first-line therapy (2-4 weeks)
- Severe/widespread disease affecting >10% BSA
- Significant psychosocial impact
- Recurrent secondary infections
- Consideration for systemic therapy
- Referral Communication: Include treatment history, response to therapies, comorbidities, current medications, impact on quality of life
Collaborative Care Models
- Shared Care Protocols: Define management algorithms with clear transitions of care
- Electronic Consultation: Virtual case reviews before formal referrals
- Integrated EMR Systems: Shared documentation of treatment plans and outcomes
- Co-management Arrangements: Alternating visits between specialties for complex cases
Knowledge Transfer Strategies
- Joint CME Programs: Cross-specialty education on AD management
- Practice-Based Learning Networks: Case-based discussions between PCPs and dermatologists
- Standardized Tools: Shared assessment metrics (EASI, POEM, DLQI) across settings
- Decision Support Systems: EMR-integrated guidelines for therapy selection
Improving Access to Dermatologic Care
- Teledermatology Options: Store-and-forward or live video consultation
- PCP Extension Programs: Dermatologist-supported management in primary care
- Nurse Practitioner/Physician Assistant Integration: Mid-level providers with specialized AD training
- Group Visits: Multidisciplinary education sessions for AD cohorts
Quality Improvement Initiatives
- Care Pathways: Standardized, evidence-based approaches across settings
- Regular Outcome Measurement: Tracking disease severity and quality of life metrics
- Patient Registries: Shared databases for monitoring complex patients
- Audit and Feedback: Regular review of referral appropriateness and outcomes
Addressing Common Challenges
- Communication Gaps: Structured referral forms with clear response expectations
- Resource Limitations: Prioritization strategies for dermatology access
- Insurance Barriers: Collaborative advocacy for coverage of needed therapies
- Geographical Disparities: Telehealth solutions for underserved areas
Future Directions
- Integrated AD Centers: Multidisciplinary clinics for complex cases
- Shared Decision-Making Tools: Patient-centered collaborative care planning
- Population Health Approaches: Risk stratification and proactive management
- Digital Health Platforms: Patient-reported outcomes shared between specialties