Connected Health May Match In-Person Ad Care

Key Takeaways

• Prespecified equivalence criteria were met over 12 months for the primary EASI outcome and for POEM and vIGA.
• Dermatologists asynchronously reviewed histories and photographs through a secure platform, and the connected health arm used less in-person specialty care.
• Safety findings were comparable, serious adverse events were uncommon and unrelated to the study interventions, no deaths occurred, and several factors may limit generalizability.

A pragmatic randomized clinical equivalence trial found that asynchronous online team-based connected health care and conventional in-person care produced comparable atopic dermatitis outcomes over 12 months.

The trial enrolled 300 pediatric and adult patients with physician-diagnosed atopic dermatitis aged 1 year or older at eight outpatient dermatology clinics in California. Of these, 149 were assigned to connected health care and 151 to conventional in-person care during enrollment from August 2019 through May 2024. In the online arm, dermatologists remotely reviewed clinical histories and photographs and returned treatment recommendations through a secure platform. They also coordinated with primary care practitioners when needed, creating a defined team-based workflow throughout follow-up.

The primary endpoint was change in the Eczema Area and Severity Index over 12 months, and the prespecified equivalence criteria were met. Quarterly secondary assessments with POEM and the validated Investigator Global Assessment also met the study's equivalence thresholds, covering patient-reported symptoms and clinician-assessed severity. Follow-up remained strong, with more than 95% of participants completing each assessment across the study period. Over 12 months, six patients in the online group required an in-person dermatologist visit, whereas the conventional group averaged 2.4 such visits per participant. Comparable clinical outcomes were paired with lower in-person specialty use in the connected health arm.

Safety outcomes were comparable between groups, and serious adverse events were uncommon and unrelated to the interventions. No deaths occurred during follow-up, and the cohort had a mean age of 35 years, with 70% of participants female at baseline. Generalizability may be limited because baseline disease severity was relatively low, internet access and digital photograph submission were required, and part of the trial occurred during the COVID-19 pandemic. These findings remain bounded to the 12-month California outpatient setting studied.