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Effects of shared medical appointments compared to individual appointments in children with atopic dermatitis: A
Wieneke T Zijlstra1,2, Harmieke van Os-Medendorp1, Karin B Fieten1
1Department of Dermatology and Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Insights
Shared medical appointments (SMAs) did not improve emotional coping or clinical outcomes for children with atopic dermatitis (AD) compared to individual appointments. This study found no additional benefits for families participating in SMAs for AD management.
Area of Science:
- Pediatrics
- Dermatology
- Health Services Research
Background:
- Atopic dermatitis (AD) significantly impacts children's quality of life and necessitates intensive management.
- Shared medical appointments (SMAs) have shown promise in managing chronic diseases, but their efficacy for pediatric AD and associated family well-being is understudied.
Purpose of the Study:
- To compare the effectiveness of SMAs versus individual appointments (IA) for pediatric AD patients and their parents.
- To assess the impact on parental emotional coping, quality of life, anxiety regarding corticosteroids, and patient disease activity.
Main Methods:
- A pragmatic randomized controlled trial involving new pediatric AD patients and their parents.
- Participants were assigned to either SMA or IA groups using covariate adaptive randomization.
- Outcomes including parental emotional coping, quality of life, corticosteroid anxiety, and disease activity were measured at baseline, 2 months, and 6 months.
Main Results:
- No significant differences were observed between SMAs and IAs in parental emotional coping, quality of life, corticosteroid anxiety, or disease activity at the 2-month primary endpoint.
- Both groups demonstrated substantial improvements over time, with a significant reduction in anxiety about corticosteroids but not in disease activity.
- The study was limited by a low response rate, necessitating advanced statistical analyses.
Conclusions:
- Shared medical appointments (SMAs) do not offer additional advantages over individual appointments (IA) for improving parental emotional coping, quality of life, corticosteroid anxiety, or disease activity in pediatric atopic dermatitis.
- Findings suggest that current models of care, whether individual or shared, lead to comparable outcomes for families managing pediatric AD.
Background:
Atopic dermatitis (AD) needs intensive treatment and has a negative impact on quality of life. Shared medical appointments (SMAs) showed to be effective in clinical outcomes of chronic diseases, but little is known about the effects on children and families.
Objective:
To evaluate the effects of SMAs compared to individual appointments (IA) for children with AD and their parents on coping and clinical outcomes.
Methods:
In a pragmatic randomized controlled trial, new patients in UMC Utrecht with AD, younger than 18 years, and their parents were assigned to the SMA group or the IA group using a covariate adaptive randomization method, controlled for age. Before the intervention, 2 months (primary time-point) and 6 months thereafter, we assessed parental emotional coping (primary outcome), quality of life, anxiety about corticosteroids and patient disease activity. Patients, parents and healthcare professionals could not be blinded to group assignment.
Results:
Of 140 patients, enrolled in the trial, 69 patients were assigned to the SMA and 71 to the IA intervention of whom 114 completed the intervention (SMA: 49; IA: 65). After 2 months, there were no differences between SMAs and IAs in effects on emotional coping: b 0.66, 95% CI -0.7 to 2.03; P = 0.33 (mean difference: 0.30; 95% CI -1.56 to 2.16; N SMA: 11; IA: 24), quality of life, anxiety about corticosteroids and disease activity. From the initial appointment to long-term follow-up, both groups showed substantial improvements, but not significant in disease activity and significant reduction in anxiety about corticosteroids. This study is limited by a low response rate; therefore, linear mixed models and dropout analyses were performed. No serious adverse events were reported.
Conclusion And Clinical Relevance:
For children with AD and their parents, there were no additional benefits of GMAs in parental emotional coping, anxiety about corticosteroids, quality of life and disease activity.
Trial Registration:
www.ISRCTN.org, ISRCTN08506572.
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