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Chronic Spontaneous Urticaria

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Patient Reports: A Key Resource in Treating Chronic Skin Conditions

—A new international study reports that awareness of patient-reported outcome measures is limited among healthcare providers who treat patients with atopic dermatitis and chronic urticaria. It鈥檚 surprising and concerning.

By Brett Moskowitz, MA
Reviewed by Sejal Makvana Bhavsar, MD

Patients who have atopic dermatitis (AD) or chronic urticaria (CU) are quick to explain that these chronic conditions impact their lives in a number of negative ways, such as impairing their sleep and their ability to handle routine daily activities, including at work and school.1,2

As with other skin conditions, there are fluctuations in the activity and control of these diseases. In the case of AD, it鈥檚 common for patients to experience unpredictable flares. In CU, exacerbations are often transient, which typically prevents clinicians from being able to visually analyze symptoms.3

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While biomarkers of disease (including D-dimer for CU and thymus- and activation-regulated chemokine for AD) may provide a useful tool in the future, they鈥檙e currently impractical and costly, according to the investigators behind a new study.3 These researchers also note that guidelines recommend the use of patient-reported outcome measures (PROMs) to determine disease status and improve quality of life.

Measuring the patient perspective

A large international team of investigators recently examined the use of PROMs in patients with AD and CU across 72 specialized allergy and dermatology centers, using a 53-item questionnaire completed by 2534 physicians in 73 countries.3 The survey was distributed by the specialty centers to both their own physicians and additional ones in their local and regional networks. Specialists and nonspecialists (general practitioners, mostly) who treat patients with AD and/or CU were included in the survey. A total of eight constructs were assessed, including demographics, knowledge about PROMs, frequency of use, PROM preferences, satisfaction with PROMs, physician training, attitudes toward PROMs, and barriers to PROM use. 

Just over half of the survey respondents (1308 out of 2534 physicians) reported being aware of PROMs. Further, PROMs were used by 26% and 28% of respondents, respectively, for AD and CU. But even among the group who said they use PROMs, half do so only 鈥渞arely鈥� or 鈥渟ometimes.鈥� Responding physicians who are female, younger, and/or a dermatologist were more likely to use PROMs for AD and CU.

The most commonly used PROMs for AD and CU were the Patient-Oriented SCORing for Atopic Dermatitis (POSCORAD) index and the Urticaria Activity Score (UAS). Respondents indicated that their main motivations for using PROMs were monitoring disease control and activity. They also reported that the major barriers to the use of PROMs were time constraints, an overall impression that patients dislike PROMs, and a lack of integration of PROMs into clinical systems.

So, what did participants say they needed with regard to PROMs? Training on which PROMs to select for AD and CU was a common desire, followed by education on interpreting PROM scores and how to administer PROMs.

We need help with PROMs, physicians say

This study had some limitations, including the fact that the survey questionnaire wasn鈥檛 validated and didn鈥檛 include questions about the use of PROMs according to disease severity. Also, because few dermatologists were represented in the study鈥攖hey made up just 18% of the total participants鈥攊t鈥檚 possible that the use of AD and CU PROMs were either overestimated or underestimated. 

Despite these limiting factors, the study鈥檚 lead investigator, Ivan Cherrez-Ojeda, MD, Universidad de Especialidades Esp铆ritu Santo, School of Medicine, Samborond贸n, Ecuador, stresses the clinical importance of this analysis in both determining physician-preferred PROMs and identifying barriers to their use.

鈥淲e found that physicians need information, training, and education regarding PROMs, especially in regard to selecting a PROM and interpreting its results,鈥� Dr. Cherrez-Ojeda told 澳门老奇人论坛. 鈥淟eadership and clinician engagement are crucial to this process.鈥�

Dr. Cherrez-Ojeda says that allergy and dermatology societies, including those that focus on AD, CU, and angioedema, 鈥渟hould promote the implementation of PROMs in routine clinical practice with a global perspective and through their educational programs. In the future, these programs should be evaluated to demonstrate the increase in PROM usage among physicians.鈥�

Published:

Brett Moskowitz writes about medicine and, in 2008, founded Bowery Consulting, which specializes in the development of medical content for healthcare professionals.

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