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Published, Version of Record (VoR)CC BY-NC-ND V4.0, Open
Journal article
Effectiveness of Online vs In-Person Care for Adults With Psoriasis A Randomized Clinical Trial
JAMA network open, v 1(6), e183062
05 Oct 2018
PMID: 30646223
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
IMPORTANCE : Innovative, online models of specialty-care delivery are critical to improving patient access and outcomes.
OBJECTIVE : To determine whether an online, collaborative connected-health model results in equivalent clinical improvements in psoriasis compared with in-person care.
DESIGN, SETTING, AND PARTICIPANTS : The Patient-Centered Outcomes Research Institute Psoriasis Teledermatology Trial is a 12-month, pragmatic, randomized clinical equivalency trial to evaluate the effect of an online model for psoriasis compared with in-person care. Participant recruitment and study visits took place at multicenter ambulatory clinics from February 2, 2015, to August 18, 2017. Participants were adults with psoriasis in Northern California, Southern California, and Colorado. The eligibility criteria were an age of 18 years or older, having physician-diagnosed psoriasis, access to the internet and a digital camera or mobile phone with a camera, and having a primary care physician. Analyses were on an intention-to-treat basis.
INTERVENTIONS : Participants were randomized 1:1 to receive online or in-person care (148 randomized to online care and 148 randomized to in-person care). The online model enabled patients and primary care physicians to access dermatologists online asynchronously. The dermatologists provided assessments, recommendations, education, and prescriptions online. The in-person group sought care in person. The frequency of online or in-person visits was determined by medical necessity. All participants were exposed to their respective interventions for 12 months.
MAIN OUTCOMES AND MEASURES : The prespecified primary outcome was the difference in improvement in the self-administered Psoriasis Area and Severity Index (PASI) score between the online and in-person groups. Prespecified secondary outcomes included body surface area (BSA) affected by psoriasis and the patient global assessment score.
RESULTS : Of the 296 randomized participants, 147 were women, 149 were men, 187 were white, and the mean (SD) age was 49 (14) years. The adjusted difference between the online and in-person groups in the mean change in the self-administered PASI score during the 12-month study period was -0.27 (95% CI, -0.85 to 0.31). The difference in the mean change in BSA affected by psoriasis between the 2 groups was -0.05% (95% CI, -1.58% to 1.48%). Between-group differences in the PASI score and BSA were within prespecified equivalence margins, which demonstrated equivalence between the 2 interventions. The difference in the mean change in the patient global assessment score between the 2 groups was -0.11 (95% CI, -0.32 to 0.10), which exceeded the equivalence margin, with the online group displaying greater improvement.
CONCLUSIONS AND RELEVANCE : The online, collaborative connected-health model was as effective as in-person management in improving clinical outcomes among patients with psoriasis. Innovative telehealth delivery models that emphasize collaboration, quality, and efficiency can be transformative to improving patient-centered outcomes in chronic diseases.
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Details
- Title
- Effectiveness of Online vs In-Person Care for Adults With Psoriasis A Randomized Clinical Trial
- Creators
- April W. Armstrong - Southern California Clinical and Translational Science InstituteCindy J. Chambers - University of California, DavisEmanual Maverakis - University of California, DavisMichelle Y. Cheng - University of California, DavisCory A. Dunnick - University of Colorado Anschutz Medical CampusMary-Margaret Chren - Vanderbilt University Medical CenterJoel M. Gelfand - University of PennsylvaniaDavid J. Wong - Stanford UniversityBrittany M. Gibbons - University of Southern CaliforniaCaitlin M. Gibbons - University of Southern CaliforniaJosefina Torres - University of Southern CaliforniaAndrea C. Steel - University of Colorado Anschutz Medical CampusElizabeth A. Wang - Univ Calif Davis, Sch Med, Dept Dermatol, Sacramento, CA 95817 USACaitlin M. Clark - University of Hawaiʻi at MānoaSanminder Singh - University of California, DavisHeather A. Kornmehl - Drexel UniversityReason Wilken - University of California, DavisAleksandra G. Florek - University of Colorado Anschutz Medical CampusAdam R. Ford - University of Southern CaliforniaChelsea Ma - College Station Medical CenterNazanin Ehsani-Chimeh - College Station Medical CenterSucharita Boddu - University of California, DavisMayumi Fujita - University of Colorado Anschutz Medical CampusPaulina M. Young - University of Southern CaliforniaCesar Rivas-Sanchez - University of Southern CaliforniaBrenda Cornejo - University of Southern CaliforniaLaura C. Serna - Southern California Clinical and Translational Science InstituteEric R. Carlson - Rocky Vista UniversityChristianne J. Lane - University of Southern California
- Publication Details
- JAMA network open, v 1(6), e183062
- Publisher
- Amer Medical Assoc
- Number of pages
- 15
- Grant note
- IHS-071502-IC / Patient-Centered Outcomes Research Institute Award; Patient-Centered Outcomes Research Institute - PCORI
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:000452647700007
- Scopus ID
- 2-s2.0-85069329237
- Other Identifier
- 991021876913104721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Dermatology