Telehealth models just as effective as in-person care when treating psoriasis patients

Telehealth care models are just as effective as in-person visits with physicians when treating patients with psoriasis, according to a study recently published in JAMA.

A California-based research team evaluated the effectiveness of telehealth models in helping patients manage their psoriasis compared to in-person physician visits. 

Previous research finds that teledermatology has had some clinical success, but several challenges still remain, study authors––April W. Armstrong, MD, with the University of Southern California Keck School of Medicine, Cindy J. Chambers, MD, and Emanual Maverakis, MD, both with the University of California Davis School of Medicine, et al.––suggested.

“Although ample evidence supports the diagnostic accuracy and reliability of asynchronous teledermatology, traditional consultative teledermatology has not been as widely adopted as previously expected,” the study said. “Real-world challenges with traditional asynchronous teledermatology include a lack of collaborative and informed communication among patients, PCPs and specialists.”

Researchers conducted a 12-month clinical trial at several community and outpatient clinics, with 296 participants. Half of the psoriasis patient participants were randomly selected to receive in-person care and the other half were randomly selected to receive online 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 authors explained. “The in-person group sought care in person. The frequency of online or in-person visits was determined by medical necessity." 

The authors tracked patient improvements by using the Psoriasis Area and Severity Index (PASI), along with improvements in body surface area (BSA) affected by the skin disease and patient global assessment score. Over time, patients saw both PASI and BSA scores drop––an indication of improving conditions.

For patients using telehealth models, their PASI scores changed from 4.68 at the beginning of the trial; 3.71 after three months; 3.50 after six months; 3.62 after nine months; and 3.04 after 12 months.

For patients using in-person visits, their PASI scores changed from 4.40 at the beginning of the trial; 3.70 after three months; 3.27 after six months; 3.58 after nine months; and 3.48 after 12 months.

"The online group achieved improvement in psoriasis disease severity equivalent to the in-person group, as measured by the PASI score," the study found.

Additionally, for telehealth patients, their mean BSA affected by psoriasis was 9.71 percent at the beginning of the trial; 7.61 percent after three months; 7.23 percent after six months; 6.88 percent after nine months; and 5.68 percent after 12 months.

For patients using in-person visits, their mean BSA affected by psoriasis was 7.67 percent at the beginning; 6.37 percent after three months; 5.02 percent after six months; 6.14 percent after nine months; and 6.51 percent after 12 months.

“The online group achieved improvement in psoriasis disease severity equivalent to the in-person group, as measured by BSA affected by psoriasis," the study read.

With the results indicating telehealth model for patients was as effective as in-person care, the authors suggested telehealth delivery models can be “transformative” in improving outcomes for patients with chronic diseases.

“The online, collaborative connected-health model emphasized patient-centeredness by fostering increased patient engagement and providing comprehensive specialist support. The robust and responsive specialist support for patients and PCPs online was a substantial improvement from some of the existing modalities of specialty healthcare delivery,” the authors concluded. “Innovative telehealth delivery models that emphasize collaboration, quality and efficiency can be transformative to improving patient-centered outcomes among those with chronic diseases.”