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Collaborating for Better Atopic Dermatitis (AD) Care: How Primary Care and Dermatology Can Work Together

Opinion
Video

A panelist discusses how effective coordination between primary care providers and dermatologists creates a complementary care model that optimizes atopic dermatitis management through shared decision-making, clear communication pathways, and defined roles for each specialty.

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
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