Practical Management of Atopic Dermatitis: Nurse Practitioner and Physician Assistant Perspectives - Episode 15

Support for Patients With Atopic Dermatitis

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Advice for healthcare professionals who treat atopic dermatitis to help them best manage patients and connect them to other supportive resources.

Melodie Young, MSN, RN, ANP-C: Are there any additional thoughts on how you develop that rapport and relationship with patients to allow you to partner with them in the journey of managing their disease?

Susan Tofte, DNP, MS, FNP-C: I agree with Keri; it is a partnership. I tell patients even with other disease entities, we’re a team, and I can’t do all of this for you, so I expect your input if something isn’t working or if you’ve gotten into a bad flare-up. We’re on electronic medical records where I work, and patients have access to send me messages. I tell them, “If you’re having a bad flare-up, send me a message. I’ll find a spot to get you in sooner than the schedulers can get you in.” Having somebody they can reach out to like that is really important, as is being able to take the time to sit down with them and have a conversation to make sure their questions are answered. We’re all under time scrutiny and deadlines in our clinics to move on to the next patient, but these patients do take time, and they take more time than somebody who comes in for acne or something like that. It’s important to be able to either get them back for another appointment quickly, or take the time that day to go through all the instructions.

Melodie, you had asked about whether dupilumab is the first thing I’d pull out of my toolbox for a patient who comes in. It’s like when you see a patient with really bad cystic acne, and you know they need Accutane. They shouldn’t have to go through any other treatment. They should be able to get right on Accutane, but they might not be able to because their insurance may not allow it, and this comes into play with these more severe patients as well. Even though it might be the treatment you reach for, you may not be able to get it right off the bat for them. That rapport is important to set up between you as the provider and your patients.

Keri Holyoak PAC-C, MPH: One simple thing you can do is to ask the patient about their goals. Two numbers that I follow closely with my patients with atopic dermatitis are, how well are you sleeping, and how bad is that itch? I also do a DLQI, which is the Dermatology Life Quality Index questionnaire, a simple 10-item questionnaire that will allow me to help understand the burden of disease and help follow them through their journey. It’s another piece of the puzzle that helps me understand them as a whole.

Melodie Young, MSN, RN, ANP-C: If you’re an NP [nurse practitioner], a PA [physician assistant], or a dermatologist who works in this field, and you don’t enjoy taking care of these patients, then refer them to a colleague because I’m sure there’s somebody else who would like to have this opportunity to partner with this patient. Don’t hesitate to refer out is one of my pieces of advice.

Douglas DiRuggiero, DMSc, PA-C: I use the phrase a lot, “We’re family now,” and family takes care of each other, and family looks after each other. I tell them there’s a lot of hope. I try to be a prescriber of hope, to let them know we have therapies we’re going to do, and we’re going to work together because I think people come in, and you’re the last hope for them. Even if I can’t get them on the medication right away, I want to say, “We’re going to work hard to try to get you as clear as possible. I want you to feel that the future is going to be better for you. We’re going to try to help you get there.” I’ve had some very dramatic experiences where that has played a part. Now I’ve had 2 patients in my years of practice who have admitted that they were going to take their own lives and commit suicide but postponed it until after the visit when they came into our office. Because of the hope that we gave them, they decided to postpone that decision. Then they confided in me 6 months later or a year later that, “The day I came to see you for the first time was the day I had already written a note and had a plan, but I just decided to keep the appointment for no good reason. But now I know the reason was that I was meant to come in.”

I think sometimes we have divine appointments, so to speak, and I try to view everything as if it could be a divine appointment and try to give them that hope. For all of these disease states we deal with, people want to know we’re there to help them with it, and certainly paramount in that are patients with atopic dermatitis.

Susan Tofte, DNP, MS, FNP-C: I refer my patients to the National Eczema Association, which is a wonderful patient advocacy group, and there’s a wealth of knowledge, caring people, and information for patients who want to affiliate with the organization. They do a patient care conference, which is in August this year. It will be virtual again, but I highly recommend that patients get plugged into that organization.

Melodie Young, MSN, RN, ANP-C: There is a necessity for collaborating with professional associations or patient associations, and then other people, like allergists and immunologists, pediatricians, and general health. Some of these people have struggled with a psychological impact from untreated disease or poorly treated disease. Sometimes it was because of the medical provider, but it’s mainly been that we haven’t had the medications needed to properly treat these patients.

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Transcript Edited for Clarity