www.primeinc.org

The evolving and growing treatment landscape for atopic dermatitis (AD) creates unique needs for collaborative patient-provider discussions that support patient education and shared decision-making to achieve individualized, patient-centered care.

This practical tool is designed to support interdisciplinary AD care teams in conducting education sessions for all their patients (and their caregivers) with AD, regardless of age or disease severity. These sessions provide a secure and interactive setting in which providers lead their patients through conversations about:

Causes, risk factors, and comorbidities of AD Goals of treatment and available treatment options Shared decision-making, and how to participate Treatment adherence and self-care

The patient-friendly handouts included in this toolkit can be used to lead educational sessions for groups or guide one-on-one patient education counseling. The accompanying speaker’s notes are included to assist healthcare teams in delivering the information using simple language for patients to understand.

Regardless of when or how you will host them, these informal sessions create a comfortable, non-judgmental setting in which patients and their loved ones are able to ask questions, share concerns, and learn from each other’s experiences. Patients should be encouraged to participate throughout in order to facilitate important dialogue, and allow the speaker to tailor the information to the patients’ baseline knowledge about AD.

Furthermore, the slide deck includes key questions to ask regarding your patients’ experiences of living with AD, to elicit their questions and concerns regarding treatment, and to share their goals for their care – which will ultimately help cultivate a shared understanding between you and your patients on how to best manage their AD and, thus, achieve the best care possible.

Ultimately, the key goal of this program is to encourage AD patients to be active participants in their health care decisions and care plan through shared decision-making, helping build a strong partnership with their provider for higher treatment satisfaction and better treatment outcomes.

Patient handouts and speaker’s notes to facilitate education in group settings or in one-on-one counseling sessions

A compilation of AD-related references and resources that providers and patients can access for additional information and support.

References and Resources

What’s included in the toolkit?

Overview

Engaging and Educating Patients to Improve Atopic Dermatitis Care: A Practical Toolkit for Clinical Teams

There is no fee for this activity as it is sponsored by PRIME® through an educational grant from Gilead Sciences, Inc.

1. American Academy of Dermatology – AD Clinical Guidelineshttps://www.aad.org/practicecenter/quality/clinical-guidelines/atopic-dermatitis

2. American Academy of Dermatology – Eczema Resource Center https://www.aad.org/public/diseases/eczema/eczema-resource-center

3. American Academy of Dermatology – Eczema Action Plan https://www.aad.org/public/diseases/eczema/eczema-resource-center/controlling-eczema/eczema-action-plan

4. National Eczema Foundation – Patient Fact Sheets: https://nationaleczema.org/eczema/patient-fact-sheets/

5. World Allergy Organization – AD Infographic https://www.worldallergy.org/UserFiles/file/WAOAtopicDermatitisInfographic2018.pdf

6. American Academy of Pediatrics – Motivational Interviewing Guidehttps://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/HALF-Implementation-Guide/communicating-with-families/Pages/Motivational-Interviewing.aspx

Welcome the group and introduce the program.  Introduce yourself as well and your role within the clinic. 

1

Open the session by sharing with the audience why you are excited to be with them, and why this session will be helpful. 

Ask the audience what brings them here and what they hope to get out of the program. 

Encourage an open dialogue throughout the program. Let participants know they can ask questions at any time. 

4

5

Emphasize that this doesn’t mean that if a patient is 

diagnosed with AD, they must have other conditions as well. It just means that they need to be extra cautious and visit their allergist if they notice any of these other conditions. 

6

Mention that AD presents differently in each and every patient. And even in the same patient, it can change! It has a cyclic nature, and it can appear different every time there is a flare. Some areas are more likely to be affected, but that doesn’t mean other areas will not. Emphasize the importance to look out for skin changes and contact their AD doctor if they start seeing new skin lesions

Photos show:1. Erythema (reddening of the skin in patches)2. Papules/spongiotic vesicles (accumulation of fluid)3. Excoriations (scrathes, scraped or abraded skin)4. Dyspegmintation (loss of normal color)5. Lichenification (hardening of the skin)

7

Point out that most treatments work by breaking the cycle one way or another — moisturizers prevent loss of water, bleach baths prevent some irritants from getting in, and steroids reduce inflammation.

8

Explain that there is a difference between how severe AD is and how controlled it can be with the appropriate treatment. 

Severity is determined by many factors, not just how bad the skin looks. It also depends how the patient has responded to topical therapy, for example. 

Most importantly, severity depends on the impact AD has had on YOUR quality of life. How well are you sleeping? Can you go to work or school? How tired are you during the day, and how it affects your daily life?

All of these questions are important to ask because these can help your AD doctor determine how severe your AD is, and it can lead to a better treatment that can help you live your life the way you want it to. 

Emphasize that their voice is important in their care, and they should always share with their doctor how they feel, and not just about their skin! 

9

10

Ask patients how AD has affected their life, and how they have coped with it. Ask them if they are comfortable sharing their quality of life, and what would prevent them from sharing? 

11

12

Mention that AD is a cyclic disease, and the goal is to move towards reducing the SEVERITY of the flares and the FREQUENCY of the flares. 

However, there are other goals that can help AD doctors determine which therapy will work best for each patient. 

Ask patients to share what goals are most important to them, or what other goals they have that are not listed. 

13

14

Emphasize that patients should talk to their care team about which treatment will work best for them, and that just as each AD is unique, each patient can also have unique responses to the treatment! 

15

If nobody in the audience shares their experience, consider sharing the experiences and treatment journeys of your own patients.

16

Explain that moisturizers work by protecting the skin from losing water. There are different types of moisturizers, so explain to patients that they may go through some trial and error until they find one that works for them. Remind the audience that in addition to moisturizers, proper bathing techniques are also important to protect the skin barrier. (You can refer them to a slide in the appendix that covers this). 

Mention that, on their own, moisturizers only help the mild cases of atopic dermatitis. However, all patients, regardless of the severity of their skin, need moisturizers to help with their skin! 

If patients ask about the difference between creams, lotions, and ointments…. • Creams contain a mixture of fat and water and feel light and cool to the skin. 

For this reason, many people with eczema prefer creams for day‐time use. All creams contain preservatives, and people can become sensitive to them, although this is not common.

• Ointments do not contain preservatives. Ointments can be very greasy and some people find them cosmetically unacceptable. However, because they are very effective at holding water in the skin, they are useful for very dry and thickened skin. Ointments should not be used on weeping eczema—use a cream or lotion instead.

• Lotions contain more water and less fat than creams, but are not very effective at moisturizing the skin. However, they are useful for hairy areas of the body.

17

Explain that, because of the potential side effects, 

topicals should only be used as prescribed! They are not 

moisturizers, so should not be in large quantities or for 

long periods of time.

18

Explain that, for patients with more severe/uncontrolled disease, experts recommend systemic therapies that work by altering your immune system – which is the body’s defense against viruses, bacteria, and others. 

Because they work by directly with your immune system, these therapies help stop the itch‐scratch cycle and allow the skin to heal. 

There are a few options available, but they each have specific considerations that patients need to discuss with their AD doctor to see if they are the right therapy for them.

Emphasize that ORAL steroids should not be taken for long periods of time. They are very helpful at controlling severe atopic dermatitis quickly, but should be used as a bridge to safer medications that can be used long‐term. 

Patients taking oral steroid should talk with their doctor about ways to reduce their use. Explain that steroids should not be stopped cold turkey! This could cause AD symptoms to rebound and flare up. 

19

20

Emphasize that Dupixent (dupilumab) and Eucrisa(crisaborole) are indicated for different patient populations, so they cannot be directly compared. While Eucrisa is indicated for mild to moderate AD, Dupixent is indicated for more severe disease patients not controlled by topical therapies.

21

Emphasize that side effects are rare and depend on many patient factors, and a lot of times they are easily managed. Encourage patients to talk with their doctors to understand their risk for side effects, how to monitor for side effects, and who to contact when you need help. 

22

23

24

Explain to patients that their opinion/voice is very important, and through shared decision making, they can talk about what is important to them with their AD doctor. 

25

Shared decision making is a continuous process. Explain to patients that their AD can change over time, so its important that they are always sharing with their AD doctor if they notice any changes or worsening symptoms – even if they don’t think its related or important! 

26

Remind patients that, before and during your medical appointments, they should ask themselves and their AD doctor these and other questions to help them identify what therapies may fit best for you. Emphasize that they should go to their medical appointments prepared with pen and paper, and that they can bring a friend/family member to help ask questions or take notes! 

28

29

Share with patients that action plans can help them stay on track to reduce, prevent, and be prepared for future AD flares. During medical appointments, they should review their action plan with their team and clarify any doubts regarding their treatment. They can think of their action plan as a “cheat sheet” for their AD treatment! 

30

Emphasize that continuous treatment will ensure long‐term health and results. The treatment only works if they take it! If they don’t think its helping, or they don’t like it, tell patients that they should share that with their AD doctor rather than making decisions by themselves. 

Ask patients what are some reasons why they are not taking their therapy. And provide suggestions as indicated below per FDA website. 

From the FDA website:• If medication side effects are bothering you, talk with your doctor or 

pharmacist about what you can do to lessen the problem. You might be able to switch to a different medication or your doctor may be able to adjust the timing of your dose. See

• Make sure you understand how long to take the medication.• Tell your doctor if paying for prescription drugs is a problem. Your 

doctor may be able to prescribe a generic medication or offer other suggestions to offset the cost of a drug. 

• You can also shop around your neighborhood or legitimate online pharmacies for the best prices on prescription drugs

• You can also: Check to see whether you are eligible for drug assistance programs in your state; or if companies that manufacture your medicines to find out whether you qualify for assistance.

• Set daily routines to take medication. It can be helpful to connect taking the medication with normal, daily activities such as eating meals or going to bed. You can also keep backup supplies of your medication at your workplace or in your briefcase or purse.

• Use daily dosing containers or keep a written or computerized schedule.

32

Encourage patients to participate in online or local support groups. Connecting with peers and building friendships with other patients going through the same challenges can help you not only share your own tips, or hear what others have done to live with AD. 

Recap the most important take away points from the session:• Recognize if AD is impacting their life more than they 

realize• Talking with their AD doctor to find a treatment that fits 

their needs• Participating in shared decision making with their AD 

doctor/team 

In case of a shy audience, share an inspirational patient story.

36

37

38

40

www.primeinc.org

Instructions to Obtain Credit

Engaging and Educating Patients to Improve AD Care:A Practical Toolkit for Clinical Teams

There is no fee for this activity as it is sponsored by PRIME® through an educational grant from Sanofi Genzyme & Regeneron Pharmaceutical.

Learning Objectives

Identify gaps in patient-provider perceptions about atopic dermatitis (AD) treatment and management

Implement leading principles, tools, and processes for engaging patients and caregivers in shared decision-making about AD therapies

Differentiate the indications, efficacy, and safety profiles of new therapies for moderate-to-severe AD

Assess patient barriers to AD treatment, adherence, and self-care, and engage interprofessional strategies for overcoming the identified barriers

Accreditation StatementsIn support of improving patient care, PRIME® is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

This activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education (IPCE) credits for learning and change.

Physician Credit Designation Statement PRIME® designates this for a maximum of 1.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity..

Physician Assistant Accreditation StatementThis program has been reviewed and is approved for a maximum of 1.0 hour of AAPA Category I CME credit by the Physician Assistant Review Panel. Physician assistants should claim only those hours actually spent participating in the CME activity. This program was planned in accordance with AAPA’s CME Standards for Live Programs and for Commercial Support of Live Programs.

Nurse Practitioner Accreditation StatementPRIME® is approved as a provider of Nurse Practitioner Continuing Education by the American Association of Nurse Practitioners. Provider number: 060815. This activity is approved for 1.0 contact hour of continuing education (which includes 0.1 hour of pharmacology) by the American Association of Nurse Practitioners. This activity was planned in accordance with AANP Accreditation Standards and Policies.

Nurse Accreditation StatementPRIME® designates this activity for 1.0 contact hour.

1. Complete the activity in its entirety.

2. Visit PRIME®’s Credit Center atwww.primeinc.org/credit.

3. Enter program code 71PR191.

4. Upon completion of the learner assessment tools, you will be able to print your certificate.

Release Date: August 1, 2019.