The Care Plan in Action

The patient with atopic dermatitis has had their initial appointment, and the dermatologist has created a perfect individualized eczema care plan. Now what? Vikash S. Oza, MD, highlights ways dermatologists can improve their eczema care plans with pearls from real-life practice. Dr Oza is an assistant professor of dermatology and pediatrics at the New York University Grossman School of Medicine in New York City, NY. He is also the program director of the pediatric dermatology fellowship program, associate program director of the dermatology residency program, and director of pediatric dermatology at NYU Langone.

Transcript

Dr Oza: It's important to understand that eczema is a chronic disease, and there is so much material to go through. It's not just your prescriptions. It's what their disease trajectory might look like, the impact of their quality of life that they might not even yet recognize sometimes.

There's a lot of information to go over, but we have to pair that with understanding that health literacy is a big issue. One in four people in the United States have difficulty understanding prescription, basic health education materials, and then we tack on top of that an incredibly complex disease state where they're getting multiple topical prescriptions.

You're telling them how to shop when they go to the store to buy products, how to shop, how to do all of these things. We have to have the resources and materials to help provide that and then to follow up with patients to ensure they're moving into the right path. We get a better sense of what the severity of their disease is and whether we need to take next steps.

I think if I thought about my general, first new patient with eczema, there's probably more than 30 complex care points that you're trying to get across. Offloading a little bit of the work is really helpful. Having some resources you can refer the patient to after the visit is fantastic. When you incorporate either photographs or video content, comprehension increases. Being able to have some resource to have the family go to is really important.

In your instructions, I think there's some key things. You want to make sure that you get across the core principle. Sometimes, you can't offer everything. You may need to offload some of that other educational materials. Now, our patients can contact us all of the time. It's very easy to add to electronic medical records. That becomes useful.

It's always a huge bummer for us when they've only come back to see us in 3 or 4 months, and they're totally not well controlled. Either that's because it's something we gave them that they didn't fully understand.

I often tell families, for instance, if we're talking purely about topical therapy, and we're talking about getting over a flare, if you're not better in 1 to 2 weeks, I want to know. I may have undershot the strength of the medicine I should have used. That gives them a sense of when they should contact you if they're not better.

Then of course, you need to also guide them in terms of what are the danger signs when we're talking about eczema, and that typically has to do with infection. Obviously, if you're having fevers, if you're noticing pus areas onto the skin, sores that are quickly developing in your skin, that might be a concern for herpetic infection of the skin.

Having instructions that go over those danger signs is important but also giving them instructions of what we expect when things aren't just not getting better from your topical therapy. When to contact us also is important.

The single most important thing you could do is what we call teach back. That's where you have the family or patient literally go over the steps you want them to follow. That's one of the core principles of health literacy education, is to ensure that the patient both, one, received the materials, they receive the education, process it, and then internalize that.

When we're teaching trainees and all of these things, one of the big things that we try to tell them is do teach back because it really will let you know whether the patient has comprehended the information.