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Patient-centered online management of psoriasis: A randomized controlled equivalency trial

This research has been presented in oral and poster format at the Association for Clinical Research Training/Society for Clinical and Translational Science, Washington, DC, April 5-7, 2010, and the National Predoctoral Clinical Research Training Program Meeting, St Louis, MO, May 3-4, 2010.

  • Cindy J. Chambers, MD, MAS, MPH

      Affiliations

    • School of Medicine, University of California, Davis, Sacramento, California
    • Department of Dermatology, University of California, Davis, Sacramento, California
    • ,
  • Kory K. Parsi, BS

      Affiliations

    • Department of Dermatology, University of California, Davis, Sacramento, California
    • ,
  • Clayton Schupp, PhD

      Affiliations

    • Department of Dermatology, University of California, Davis, Sacramento, California
    • ,
  • April W. Armstrong, MD, MPH

      Affiliations

    • Department of Dermatology, University of California, Davis, Sacramento, California
    • Corresponding Author InformationReprint requests: April W. Armstrong, MD, MPH, Department of Dermatology, University of California Davis Health System, 3301 C St, Suite 1400, Sacramento, CA 95816.

Accepted 28 May 2011. published online 05 September 2011.
Corrected Proof

Background

Previous research suggests that technology-enabled health care delivery may improve access to dermatologic specialty care. Outcomes research using validated outcomes measures is necessary for evaluation of novel health care delivery models.

Objective

We sought to compare the clinical equivalence of a novel patient-centered online health care delivery model with standard in-office care for follow-up treatment of patients with psoriasis.

Methods

A total of 64 participants with psoriasis were randomized to receive follow-up care either in-office or online over a 24-week period. Patients randomized to the online group underwent standardized training on capturing high-quality digital images of their psoriatic skin and transmitting these images and clinical history to a dermatologist securely. The dermatologist then performed asynchronous, online evaluation and provided recommendations directly to patients. We used clinically validated disease severity and quality-of-life measures to assess effectiveness between the models.

Results

Both online and in-office groups showed improvement in psoriasis disease severity as measured by mean improvement in Psoriasis Area and Severity Index (online group: mean = –3.4, in-office: mean = –3.4). Patient-centered online care resulted in similar improvement in psoriasis severity compared with in-person follow-up care (mean difference in Psoriasis Area and Severity Index change 0.1, 95% confidence interval –2.2 to 2.3, a priori equivalence margin of 2.5). Investigator Global Assessment and Dermatology Life Quality Index scores also improved during the study period; no significant differences existed between the two groups.

Limitations

The follow-up period was limited to 24 weeks.

Conclusion

A patient-centered online model may be an effective alternative to in-office care for follow-up management of psoriasis.

Key words: asynchronous teledermatology, comparative effectiveness, e-health, e-medicine, equivalency trial, psoriasis, randomized controlled clinical trial, store-and-forward teledermatology, teledermatology, telemedicine

Abbreviations used: CI, confidence interval, DLQI, Dermatology Life Quality Index, IGA, Investigator Global Assessment, PASI, Psoriasis Area and Severity Index

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 Supported by grant No. UL1 RR024146 from the National Center for Research Resources.

 Contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of National Center for Research Resources or National Institutes of Health. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp.

 Disclosure: Dr Armstrong is an investigator and consultant to Abbott and Centocor. Drs Chambers and Schupp, and Mr Parsi have no conflicts of interest to declare.

PII: S0190-9622(11)00687-6

doi:10.1016/j.jaad.2011.05.047

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