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Failing to Clarify Treatment Action Plans With Mom in Pediatric Atopic Dermatitis: Comment on “Maternal Adherence Factors in the Treatment of Pediatric Atopic Dermatitis”

Failing to Clarify Treatment Action Plans With Mom in Pediatric Atopic Dermatitis: Comment on... The report by Fenerty et al highlights common difficulties in physician-patient interaction that can directly impact adherence to desired treatments, in this case for atopic dermatitis. This group and others have studied adherence to treatment regimens in the past. The gap highlighted in this publication is communication. Physicians have long assumed that information given during office or hospital visits will be carried out appropriately. More recently, as reported by Sleath et al,1 the use of a shared decision-making model in the clinical arena has been stressed by the US Institute of Medicine. The concept of patient-centered care is now common practice in many areas. Involvement of the caregiver is critical to successful treatment. The authors highlight that mothers are the usual caregivers for their children's medical conditions. They appropriately highlight measures such as discussing the disease process and administration of medication as being key to successful therapies. Families do not routinely feel comfortable with the overall management of their children's skin disease.2 Taking time to engage the caregivers and (when feasible) the patients in these discussions is critical.1 Awareness of cultural and other family needs must be included. Demonstrating topical application methods or physically identifying specific areas for application may better clarify verbal or written instructions. Any concerns that the family or patient might have must be elicited and addressed by the physician, a process often requiring strong communication skills. These practices are not new and have been used in the management of other diseases such as asthma, where identical measures have proven their efficacy. An additional adherence enhancement tool that I have used successfully in my practice for many years for pediatric patients with atopic dermatitis is a treatment action plan (eFigure) that outlines, in stepwise fashion, interventions for care. These plans can be used for some families with careful explanation in addition to each of the measures suggested by Fenerty et al. As physicians, we must engage our patients and their caregivers in the care of all disorders, including atopic dermatitis. This requires additional time and training for some. The practice, however, has demonstrated efficacy.1 Spending the extra time initially might lead to less time needed in follow-up. To close the communication gap between physicians and the caregivers for their pediatric patients requires that we, as practitioners, be willing to take the time and effort to do so. Engaging our staff in this effort is key, as well. This practice is key to the principle of shared decision making and can result in better overall clinical outcomes. Back to top Article Information Correspondence: Dr Levy, Department of Pediatric/Adolescent Dermatology, Dell Children's Medical Center of Central Texas, 4900 Mueller Blvd, Austin, TX 78723 (mlevy@sfcaustin.com). Conflict of Interest Disclosures: None reported. References 1. Sleath B, Carpenter DM, Slota C, et al. Communication during pediatric asthma visits and self-reported asthma medication adherence. Pediatrics. 2012;130(4):627-63322945409PubMedGoogle ScholarCrossref 2. Ellis RM, Koch LH, McGuire E, Williams JV. Potential barriers to adherence in pediatric dermatology. Pediatr Dermatol. 2011;28(3):242-244.21615470PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Dermatology American Medical Association

Failing to Clarify Treatment Action Plans With Mom in Pediatric Atopic Dermatitis: Comment on “Maternal Adherence Factors in the Treatment of Pediatric Atopic Dermatitis”

Levy, Moise L.
JAMA Dermatology , Volume 149 (2) – Feb 1, 2013
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Failing to Clarify Treatment Action Plans With Mom in Pediatric Atopic Dermatitis: Comment on “Maternal Adherence Factors in the Treatment of Pediatric Atopic Dermatitis”

Abstract

The report by Fenerty et al highlights common difficulties in physician-patient interaction that can directly impact adherence to desired treatments, in this case for atopic dermatitis. This group and others have studied adherence to treatment regimens in the past. The gap highlighted in this publication is communication. Physicians have long assumed that information given during office or hospital visits will be carried out appropriately. More recently, as reported by Sleath et al,1 the use...
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Publisher
American Medical Association
Copyright
Copyright © 2013 American Medical Association. All Rights Reserved.
ISSN
2168-6068
eISSN
2168-6084
DOI
10.1001/jamadermatol.2013.2411
Publisher site
See Article on Publisher Site

Abstract

The report by Fenerty et al highlights common difficulties in physician-patient interaction that can directly impact adherence to desired treatments, in this case for atopic dermatitis. This group and others have studied adherence to treatment regimens in the past. The gap highlighted in this publication is communication. Physicians have long assumed that information given during office or hospital visits will be carried out appropriately. More recently, as reported by Sleath et al,1 the use of a shared decision-making model in the clinical arena has been stressed by the US Institute of Medicine. The concept of patient-centered care is now common practice in many areas. Involvement of the caregiver is critical to successful treatment. The authors highlight that mothers are the usual caregivers for their children's medical conditions. They appropriately highlight measures such as discussing the disease process and administration of medication as being key to successful therapies. Families do not routinely feel comfortable with the overall management of their children's skin disease.2 Taking time to engage the caregivers and (when feasible) the patients in these discussions is critical.1 Awareness of cultural and other family needs must be included. Demonstrating topical application methods or physically identifying specific areas for application may better clarify verbal or written instructions. Any concerns that the family or patient might have must be elicited and addressed by the physician, a process often requiring strong communication skills. These practices are not new and have been used in the management of other diseases such as asthma, where identical measures have proven their efficacy. An additional adherence enhancement tool that I have used successfully in my practice for many years for pediatric patients with atopic dermatitis is a treatment action plan (eFigure) that outlines, in stepwise fashion, interventions for care. These plans can be used for some families with careful explanation in addition to each of the measures suggested by Fenerty et al. As physicians, we must engage our patients and their caregivers in the care of all disorders, including atopic dermatitis. This requires additional time and training for some. The practice, however, has demonstrated efficacy.1 Spending the extra time initially might lead to less time needed in follow-up. To close the communication gap between physicians and the caregivers for their pediatric patients requires that we, as practitioners, be willing to take the time and effort to do so. Engaging our staff in this effort is key, as well. This practice is key to the principle of shared decision making and can result in better overall clinical outcomes. Back to top Article Information Correspondence: Dr Levy, Department of Pediatric/Adolescent Dermatology, Dell Children's Medical Center of Central Texas, 4900 Mueller Blvd, Austin, TX 78723 (mlevy@sfcaustin.com). Conflict of Interest Disclosures: None reported. References 1. Sleath B, Carpenter DM, Slota C, et al. Communication during pediatric asthma visits and self-reported asthma medication adherence. Pediatrics. 2012;130(4):627-63322945409PubMedGoogle ScholarCrossref 2. Ellis RM, Koch LH, McGuire E, Williams JV. Potential barriers to adherence in pediatric dermatology. Pediatr Dermatol. 2011;28(3):242-244.21615470PubMedGoogle ScholarCrossref

Journal

JAMA Dermatology – American Medical Association

Published: Feb 1, 2013

Keywords: atopic dermatitis,dermatitis,mothers,pediatrics

References

  • Communication during pediatric asthma visits and self-reported asthma medication adherence.
    Sleath B; Carpenter DM; Slota C
  • Potential barriers to adherence in pediatric dermatology.
    Ellis RM; Koch LH; McGuire E; Williams JV

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