The Need for Objective and Remote Tracking of Chronic Skin Diseases

Abstract

Importance: Managing chronic skin disease is often frustrating for both providers and patients, sometimes resulting in delayed diagnosis, inadequate therapy, and inconsistent care.Objective: This study performs stakeholder analyses to identify unmet clinical needs in chronic skin disease management. Methods: Survey of 33 providers and 25 patients at a Stanford Health Care Dermatology department.Results: When evaluating a chronic skin condition such as psoriasis, 79% of dermatologists rely solely on subjective documentation (gestalt, body surface area, descriptive exam). Objective documentation (photographs or scoring assessment tools) is used by 21% of providers upon initial assessment and by 7% of providers to assess change in disease between office visits. While 83% of providers were comfortable assessing change in disease severity based on prior document by oneself, only 31% were comfortable assessing change based on prior documentation by another provider (p <0.001). Dermatologists expressed the need for better documentation modality in clinic (94%), and in between office visits by patients (91%). While 90% of patients reported it is moderately to extremely important to track their disease, only 16% of patients consistently do. Most patients preferred to monitor their disease at home (92%) using cameras (80%) or by smartphone (59%). Patients were willing to spend 5-30 minutes weekly to monthly to document their disease.Conclusions and Relevance: This study identifies that dermatologists and patients need a solution that objectively and remotely monitors chronic skin diseases to optimize treatments, empower patients, and provide more cohesive care in a complex healthcare system.