School of Medicine, University of California, Davis, Sacramento, California, USA.
J Am Acad Dermatol. 2012 Jun;66(6):948-53. doi: 10.1016/j.jaad.2011.05.047. Epub 2011 Sep 3.
Previous research suggests that technology-enabled health care delivery may improve access to dermatologic specialty care. Outcomes research using validated outcomes measures is necessary for evaluation of novel health care delivery models.
We sought to compare the clinical equivalence of a novel patient-centered online health care delivery model with standard in-office care for follow-up treatment of patients with psoriasis.
A total of 64 participants with psoriasis were randomized to receive follow-up care either in-office or online over a 24-week period. Patients randomized to the online group underwent standardized training on capturing high-quality digital images of their psoriatic skin and transmitting these images and clinical history to a dermatologist securely. The dermatologist then performed asynchronous, online evaluation and provided recommendations directly to patients. We used clinically validated disease severity and quality-of-life measures to assess effectiveness between the models.
Both online and in-office groups showed improvement in psoriasis disease severity as measured by mean improvement in Psoriasis Area and Severity Index (online group: mean = -3.4, in-office: mean = -3.4). Patient-centered online care resulted in similar improvement in psoriasis severity compared with in-person follow-up care (mean difference in Psoriasis Area and Severity Index change 0.1, 95% confidence interval -2.2 to 2.3, a priori equivalence margin of 2.5). Investigator Global Assessment and Dermatology Life Quality Index scores also improved during the study period; no significant differences existed between the two groups.
The follow-up period was limited to 24 weeks.
A patient-centered online model may be an effective alternative to in-office care for follow-up management of psoriasis.
先前的研究表明，基于技术的医疗保健模式可能会改善皮肤科专业护理的可及性。为了评估新型医疗保健模式，需要使用经过验证的结局评估方法进行相关的效果研究。
我们旨在比较一种新型以患者为中心的在线医疗保健模式与标准门诊护理在治疗银屑病患者后续治疗中的临床等效性。
共有 64 名银屑病患者被随机分配到门诊或在线组，在 24 周的时间内接受后续治疗。随机分配到在线组的患者接受了关于如何高质量拍摄自身银屑病皮肤图像并将这些图像和临床病史安全传输给皮肤科医生的标准化培训。然后，皮肤科医生进行异步在线评估，并直接向患者提供建议。我们使用经过临床验证的疾病严重程度和生活质量评估方法来评估两种模式之间的效果。
在线组和门诊组的银屑病严重程度均有改善，衡量指标为银屑病面积和严重程度指数（在线组平均改善值为 -3.4，门诊组平均改善值为 -3.4）。与门诊随访相比，患者为中心的在线护理在改善银屑病严重程度方面效果相当（Psoriasis Area and Severity Index 变化的平均差异为 0.1，95%置信区间为 -2.2 至 2.3，预先设定的等效性边界为 2.5）。研究期间，研究者整体评估和皮肤病生活质量指数评分也有所改善；两组之间没有显著差异。
随访时间限制为 24 周。
以患者为中心的在线模式可能是门诊护理的有效替代方案，可用于银屑病的后续管理。
