33496 Multidisciplinary atopic dermatitis program: A novel approach to managing difficult-to-control atopic dermatitis patients

Abstract

The Multidisciplinary Atopic Dermatitis Program (MADP) is a specialized clinic with collaborative efforts between the Rady/UCSD Divisions of Dermatology and Allergy/Immunology. MADP clinic is a novel, team-based approach with experts working in conjunction with Clinical Pharmacy providing care for pediatric patients with severe and/or difficult to control atopic dermatitis. The program includes monthly clinic visits, standardization of Electronic-Medical- Record intake forms, consistent management protocols, creation/use of guidelines-based education modules, implementation of shared-decision-making (SDM) processes, and assessment of patient and provider reported outcomes. Out of 33 subjects, 69.7% (23/32) achieved EASI 50 with 63.6% (21/33) achieved within 6 months. 48.5% (16/33) achieved EASI 75 with 42.4% (14/33) achieved within 6 months. EASI scores increasingly declined over visits, with a mean decrease of 10.9% (P < .001) by visit 2, 17.4% (P < .001) by visit 3, and 21% (P < .001) by visit 4. BSA increasingly declined with each consecutive visit with mean decreases of 18.9% (P < .001) by visit 2, 31.7% (P < .001) by visit 3 and 39.1% (P < .001) by visit 4. vIGA achieved a mean decrease of 1.00 (P < .001) by visit 2 and 2.00 (P = .010 and N = 7) by visit 5. Patient reported outcomes also showed clinically significant decreases. POEM scores reached greatest mean decrease of 5.7 (P < .001) by visit 3, CDLQI scores reached the greatest mean decrease of 9.69 (P = .002) by visit 4, and Pruritus reached greatest mean decrease of 2.86 (P < .001) by visit 3. Based on provider and patient reported outcomes, our multidisciplinary model has demonstrated significant disease improvement and improved quality of care in patients.