Effects of Shared Medical Appointments Compared With Individual Appointments in Children With Atopic Dermatitis: A Pragmatic Randomized Controlled Trial

To evaluate the effects of shared medical appointments (SMA) compared with individual appointments (IA) for children with atopic dermatitis and their parents. Parental emotional coping, quality of life, anxiety about topical steroid treatment and patient disease activity were assessed through questionnaires. SMA or group visits were conducted with clinicians seeing multiple patients simultaneously, combining individualized patient care with peer support and self-management education. This format has been successfully used for children and their families with other chronic health conditions such as diabetes and hemophilia.

Children younger than 18 years who were diagnosed with atopic dermatitis and were being seen as a new patient at a university pediatric dermatology department were randomly assigned 1:1 to SMA or IA group. Blinding to group assignment was not possible.

After obtaining baseline data, all patients attended an individual intake visit with the dermatologist for initiation of therapy directly followed by a visit to the dermatology nurse. For subsequent follow-up visits, both groups of patients (SMA versus IA) had three appointments within a 6 month time frame. For patients assigned to SMA group, appointments consisted of 5–8 patients accompanied by one/two parents lasting 1 1/2 to 2 hours; both the dermatologist and dermatology nurse were present at these appointments. For patients assigned to IA group, two appointments consisted of encounters with the dermatologist lasting ∼15 minutes and one appointment with dermatology nurse lasting ∼30 minutes. The dermatologist focused on medical questions, health concerns and provided medical treatment. The dermatology nurse provided information about adherence/compliance, the how-tos of applying topical products and discussed coping with itch. Parental emotional coping, quality of life, anxiety about corticosteroids and patient disease activity were assessed via valid and reliable questionnaires at four time points: baseline after inclusion, after the third SMA or IA, 2 months after third SMA or IA and 6 months after third SMA or IA.

140 patients were enrolled in the study with 69 patients randomized to SMA group and 71 to the IA group; 114 patients (49 SMA and 65 IA) completed the study. There was no difference in response rates comparing SMA and IA group. Overall, both groups demonstrated a significant decrease in anxiety about corticosteroid usage (P = .01) and a small but not significant improvement in maternal coping, quality of life scores, and disease activity. However, there was no significant difference at any time points between the two groups.

This randomized controlled trial showed no additional benefit of SMA compared with IA on maternal emotional coping, quality of life, anxiety about corticosteroid usage, or disease activity in children with atopic dermatitis.

There are clinic days when I feel like I’m Bill Murray in the movie Ground Hog Day repeating the same advice to patients and their families. I have often wondered if families would find a group setting to review general recommendations more useful and to hear input from other families how they approach disease management. This study did not sway me one way or the other.