599 Bringing therapeutic patient education in atopic dermatitis into the 21st century: A novel, low-cost, personalized, electronic health record-based framework

Abstract

The term “therapeutic patient education” (TPE) refers to teaching by healthcare practicioners that is designed to help patients and families manage chronic disease and improve quality of life. TPE improves treatment adherance, reduces complications, reduces overall cost of care and improves survival in congestive heart failure, diabetes mellitus and rheumatoid arthritis, among other diseases. Stalder et al and other groups have described implementation of TPE for atopic dermatitis (AD). Widespread implementation of TPE programs for AD has been limited by issues of cost, limited time during a clinic visit, and patient willingness to attend educational sessions outside the clinic visit. To address these difficulties, we developed a novel framework for TPE centered on the after-visit summary (AVS) in the EpicTM electronic health record (EHR) and applied it to a cohort of approximately 400 pediatric atopic dermatitis patients seen by 20 pediatricians. Our objective was to personalize the educational materials without increasing provider work-burden or adding substantial cost to AD care. A cubic regression of fingertip units (FTU) of topical ointment or cream needed to cover 100% of the body at any given age was generated based upon published data, as well as a quartic regression of FTU of topical ointment or cream needed to cover 100% of the face at any given age. Assessment of body surface area involved and patient age allows an EHR script to be generated with recommended quantity of topical agent to be utilized, which is incorporated into printed patient handout materials. Patients’ perceived control over their disease, knowledge of treatments and self-efficacy are being measured at baseline and followup. This project is currently ongoing; patient pools for pediatricians have been identified and all TPE materials have been written and coded. TPE materials developed from existing clinical practice guidelines will be presented.