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

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