Addressing Social Determinants of Health to Improve Care for Patients With Atopic Dermatitis

Raj Chovatiya, MD, PhD, director, Center for Eczema and Itch, Northwestern University, offers insight into how social determinants of health affect care access and quality for patients with atopic dermatitis.

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Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network where we combine expert commentary and exclusive insight into key issues in population health management and more.

In this episode, Dr Raj Chovatiya discusses the social determinants of health (SDoH) affecting care access for patients with atopic dermatitis.

Hi there. My name is Dr Raj Chovatiya. I'm an assistant professor of dermatology and director of the Center for Eczema and Itch at the Northwestern University of Feinberg School of Medicine in Chicago, Illinois.

What SDoH influence patients’ access to atopic dermatitis care?

This is a huge question, and probably an essay in its own right. Generally, when I think about SDoH, I'm thinking about overarching concepts like economic stability, social and community context, neighborhood and environment, education, and access to quality care.

We know there are huge disparities when it comes to atopic dermatitis. In particular, a large brunt of the disease is borne by people that oftentimes do not have the best access, education opportunity, and health insurance. Disease tends to be worse in inner cities and areas that don't have great nutrition, water, or sanitation.

In general, individuals that have economic instability tend to have greater disease burden and inability to access treatments as well. SDoH are everything when it comes to dermatologic and chronic disease, but with atopic dermatitis, it’s elevated to another level. SDoH make it difficult not only to reach people who truly need the care, but also to figure out how we can keep them plugged into the health care system in the long run.

And how might providers, payers, and health systems help address these SDoH?

Another billion-dollar question. I think it starts from all aspects.

From the provider angle, it’s about making sure to understand the individual context of each of our patients. The same way that we say no two cases of eczema are the same, no two structural cases are the same between patients. What I mean is to understand somebody's ability to access specialty care.

Would telehealth be a good option if it's hard for them to come in to see you? In terms of treatments, how can you simplify the regimen to lower costs for an individual so they're able to keep up with their treatments? Simplify the plan. Use language that's easy to follow and understand to really increase adherence from that standpoint.

From the managed care perspective, eliminate some of these burdens of step therapy. It oftentimes is already difficult to manage severe disease. These folks do not have the ability go through each of these therapies before we can get to the treatment that actually works.

From the standpoint of industry and folks that are making the medications, make sure we continue innovation in that regard so we can get medications that are accessible, work really well, and are easy to use. We can keep adherence in mind from that standpoint.

Then, obviously, from the patient standpoint, be an advocate for yourself, and know that your resources may not be the same as someone else. Emphasize how a particular treatment plan or disease is impacting your life, and let your provider know that. Be an active participant in the management of your disease.

Where do you see the future headed as new treatments become available?

The exciting thing about atopic dermatitis is we have hundreds of new therapies in the pipeline. We have a handful that have been approved in the past several months, and more that are coming in the next few years. This is for a disease space that was starving for good therapies.

But now, we're going to face an interesting problem: we're going to have a glut of therapies—topical, systemic, injectable, and oral—but how can we make sure we get the right therapy to the right patient?

The tough part always is, how many things does someone have to fail to satisfy any particular insurer so we can get the therapy we want? I think everybody should come together at the table and try to figure out how we quickly get a patient to a treatment with as few steps and bumps along the way.

I think another aspect is increasing education and uptake of new treatments in the provider community as well. Knowing that we have a lot of great, safe, effective options, and realizing it’s time to put aside some the treatments we've been using for 50 years that may be based on limited or no evidence, in favor of things that are going to do right by patients.

From the patient's standpoint, hopefully we increase education so people become advocates for their own disease and understand current treatment evolution. I know my patients love to hear the story of how all these treatments are coming and how they work. Even if their background isn’t in medicine, I think it really helps to empower them.

Thank you, Dr Chovatiya. Is there anything else you wanted to add?

Like I said, it’s an exciting time for chronic inflammatory skin diseases, even beyond atopic dermatitis. We're seeing evolution, innovation, and new therapies left and right.

But in the case of atopic dermatitis, hopefully we can stop thinking about it as just topical steroids and conventional oral immunosuppressive agents and consider the whole spectrum of therapies. And connect the right patient with the right therapy, with as minimal effort as possible.

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This transcript has been edited for clarity.