Multidisciplinary Management of Atopic Dermatitis



Peter A. Lio, MD: There has been a big movement toward this multidisciplinary approach in many complex chronic diseases, and atopic dermatitis is 1 of them. I honestly think there is tremendous potential to benefit everybody involved when we use a multidisciplinary approach, especially for those more moderate and severe patients. Obviously, you can’t offer that to every patient. We’ve already said that this is an incredibly common condition, but for those who are really struggling and might need a little more, it is fantastic. The truth is it doesn’t necessarily need to be a fancy, organized clinic in 1 academic center where everybody converges on the patient at once. Of course, we know that’s an amazing way to do it, but it’s highly luxurious, it’s very inefficient to have all the specialists sitting around at once. It can be difficult to take care of more than a tiny handful of patients per year that way.

Instead, something that can imitate this approach, or take some of the best aspects of it, is to have a network of practitioners who understand another, who get along with one another, and can work to create a therapeutic alliance for their patients. That’s what we’ve done in Chicago. I don’t have everybody in my office seeing patients with me. It would be fun if I did. I would love it, but it is just not feasible. What we do instead is we have a group of people we work with, whom we can communicate with, so we can understand one another’s style and help support one another. In the worst of worlds, you might have two specialists who go head-to-head, and they don’t agree. Then the poor patient is stuck in the middle saying, “What do I do if they’re disagreeing about my approach?” That makes things stressful for everybody involved.

There are a number of different initiatives in trying to get better treatment approaches, better support materials, and ultimately better care for patients all over the world. One of the ones I’m involved with is working closely with the National Eczema Association, which is a patient nonprofit group that really focuses on support and education for patients and clinicians.

But there are a number of other initiatives, and it’s been fascinating. Many pharmaceutical companies are developing new treatments and putting a stake in the game. They want to increase understanding and access for patients because ultimately, the only way patients will get those fancy treatments that they’re developing is if they get proper treatment leading up to it and get to the specialist. In a weird way, that is actually helping everybody; it often does. We have the concept of all ships rising. There are a number of stakeholders who are interested in improving that, but it’s going to take a lot. It’s going to take a lot of time and a lot of energy, especially because there’s tremendous health care disparity, not only across the world but just across the United States. Different parts of a city are different, different parts of the country, and there are some rural areas where it may be very difficult.

However, we now have the new telehealth initiatives that can bridge some of those gaps. With better education and new tools like the internet, with high-speed access to different types of video visits, educational information, and new apps that are creative, we’ve even seen those helping patients track their eczema severity and report that back to their doctors. I think we’re going to be able to bridge those gaps better than ever.

The COVID-19 [coronavirus disease 2019] pandemic has been terrible for most people, doctors included. If there is a silver lining it is that it has pushed us into the future a little. One of the benefits has been that it has pushed telehealth on everybody a little faster. I’ve been interested in telehealth for more than 10 years honestly. Even 15 years ago we were dabbling in it, but it just never seemed to take off. The truth is, in part, that because most insurance companies didn’t acknowledge it, they didn’t cover it. So many medical centers say, “Well, we can’t do it, if the insurers aren’t going to be on board.” Patients don’t want to pay out of pocket for a telehealth visit; they’d rather come in.

But with COVID-19, we see many insurers say, “Yes, just go ahead and do it. Document it correctly.” They’ve really been pretty picky. You can’t just send a photo, which some patients would prefer. Sometimes it would be nice just to look at a photo and send it back. But when there is a live video visit simulating a clinic visit, they are reimbursed at a similar rate. That is has opened the door for a new set of people to get involved. What’s been interesting for me, as someone who’s focused on atopic dermatitis, is that they have released some of the restrictions on interstate practicing of medicine.

Typically, if a patient calls me from Georgia or from Florida, I say, “You have to come, I can’t practice across state lines.” But with the pandemic they’ve opened that up, so now I have some out-of-state patients saying, “I’m so glad we can see you remotely. I’d love your input. I’d love your thoughts.” I don’t know how long that will last, but hopefully some pieces of this, the good pieces, will stay on. That’s going to be a win-win for access for everybody.

Transcript Edited for Clarity

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