Care pathways in atopic dermatitis: a retrospective population-based cohort study

Abstract

Background: Atopic dermatitis (AD) is a complex disease with variations in severity and healthcare utilization. Examining patient pathways through analyses of longitudinal patient data provides an opportunity to describe real-world clinical patient care and evaluate healthcare access and treatment.

Objective: To describe longitudinal care pathways including health care management, treatment patterns and disease progression (by proxy measures) in patients with AD.

Materials and methods: This was a longitudinal observational study, which used linked data from national and regional healthcare registers in Sweden. Patients with AD were identified through diagnosis in primary or secondary care or by dispensed medications. Descriptive statistics for number of healthcare visits, type of dispensed drug class, rate of - and time to - referral to secondary care and treatment escalation were calculated.

Results: A total of 341 866 patients with AD distributed as 197 959 paediatric (age < 12), 36 133 adolescent (age ≥ 12- < 18) and 107 774 adult (age ≥ 18) patients were included in this study. Healthcare visits to primary and secondary care and dispensation of AD-indicated treatments were more common during the year in which managed AD care was initiated. Topical corticosteroids (TCSs) and emollients were the most frequently used treatments across all age cohorts while systemic treatment was uncommon in all age cohorts. Among patients who initiated treatment with TCSs, 18.2% escalated to TCSs with higher potency following the start of managed AD care.

Conclusions: We found that healthcare contacts and use of AD-indicated treatments were concentrated in the year during which managed AD care was initiated and decreased significantly thereafter. Since a significant proportion of patients with AD have flares and persistent AD, our results suggest that patients with AD may be monitored infrequently and are undertreated. There is a need to inform practitioners about adequate treatment options to provide individualized care, in particular for patients with persistent severe AD.

Figure 1

Schematic of study design: *Exceptions: Baseline disease severity was defined at index to – and including – 1 year after index, socioeconomic variables (income, education and employment) were defined in the calendar year prior to index, age and gender at index date, and healthcare resource use during 1 year prior to index date.

Figure 2

Mean number of annual AD‐related healthcare visits after index by patient: AD‐related healthcare resource use (HCRU) from index date and the 5 years thereafter. The error bars represent the 95% confidence intervals. [Colour figure can be viewed at wileyonlinelibrary.com]

Figure 3

Proportion of patients with at least one prescription of topical therapies: in A) paediatric patients (top panel) and B) adolescent patients (bottom panel) following index date. [Colour figure can be viewed at wileyonlinelibrary.com]

Figure 4

Proportion of adult patients with at least one prescription of topical therapies (top panel) and systemic therapies (bottom panel). [Colour figure can be viewed at wileyonlinelibrary.com]

Figure 5

AD disease progression over time: This figure shows the proportion of patients by disease severity and transitions between severity groups over time after index date. Panel A shows paediatric patients, panel B shows adolescent patients and panel C shows adult patients. [Colour figure can be viewed at wileyonlinelibrary.com]