Patient-Reported Outcome Measures in Atopic Dermatitis and Chronic Urticaria are Underused in Clinical Practice

Cherrez-Ojeda I, Bousquet J, Giménez-Arnau A et al.  J Allergy Clin Immunol Pract. 2024 Apr 9:S2213-2198(24)00349-0. doi: 10.1016/j.jaip.2024.03.050. 

Abstract

Background: Patient-reported outcome measures (PROMs) are validated and standardized tools that complement physician evaluations and guide treatment decisions. PROMs are crucial for monitoring atopic dermatitis (AD) and chronic urticaria (CU) in clinical practice, but there are unmet needs and knowledge gaps regarding their use in clinical practice.

Objective: We investigated the global real-world use of AD and CU PROMs in allergology and dermatology clinics as well as their associated local and regional networks.

Methods: Across 72 specialized allergy and dermatology centers and their local and regional networks, 2,534 physicians in 73 countries completed a 53-item questionnaire on the use of PROMs for AD and CU.

Results: Of 2,534 physicians, 1,308 were aware of PROMs. Of these, 14% and 15% used PROMs for AD and CU, respectively. Half of physicians who use PROMs do so only "rarely" or "sometimes". AD and CU PROM usage is associated with being female, younger, and a dermatologist. POSCORAD and UAS were the most utilized PROMs for AD and CU, respectively.

Monitoring disease control and activity are the main drivers of the use of PROMs. Time constraints were the primary obstacle to using PROMs, followed by the impression that patients dislike PROMs. AD and CU PROM users would like training in selecting the proper PROM.

Conclusion: Even though PROMs offer several benefits, their use in routine practice is suboptimal, and physicians perceive barriers to their use. It is essential to attain higher levels of PROM implementation in accordance with national and international standards.

Highlights:

• What is already known about this topic? The significance of PROMs in managing AD and CU is well recognized; however, from the limited data available, it is evident that their utilization rates are very low.

• What does this article add to our knowledge? It highlights the considerable global underuse of PROMs, identifies the barriers to their wider adoption, and underlines the strong demand for clinician training in their proper use.

• How does this study impact current management guidelines? The findings advocate for a revision of current management guidelines to incorporate validated PROMs like UAS7, UCT, CU-Q2oL for CU, and PO-SCORAD, DLQI, NRS for AD, emphasizing the urgent need for educational initiatives to enhance clinician proficiency in these tools.

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