- Email: [email protected]
A randomized, controlled trial evaluating adherence to sunscreen using electronic monitoring and text message reminders
P1638
P1701
Comparative effects of an antiinflammatory blend on reducing skin irritation caused by ultraviolet B light or a chemical irritant to 1% hydrocortisone Donald Collins, Clinique Laboratories, Melville, NY, United States; Chia Chen, Clinique Laboratories, Melville, NY, United States; Daniel Maes, Clinique Laboratories, Melville, NY, United States; Neelam Muizzuddin, Clinique Laboratories, Melville, NY, United States It is of considerable interest to develop a topical agent containing no hydrocortisone (HC) that can both reduce the onset of chemically- or environmentally-induced skin irritation and ameliorate this irritation once it occurs. A blend of ingredients with antiinflammatory activities has been developed that outperforms topical 1% HC with regard to ultraviolet B light (UVB)-induced or balsam of Peru (BOP)-induced skin irritation. This blend contains an inhibitor of histamine release, inhibitors of the PLA2, 5-LO, COX-2, collagenase, elastase, and PDE IV enzymes, neutrophil chemotaxis and adhesion blockers, a histamine receptor blocker, and an inhibitor of nuclear factor kappa beta activation. A cosmetically acceptable oil/water emulsion containing the antiinflammatory ingredients was prepared and applied to human subjects either 20 minutes before exposure to the irritant (UVB or BOP) or after irritant exposure once erythema was achieved. When applied before the irritant, this blend was able to reduce BOP-induced erythema by 82% and UVB-induced erythema by [90%. When applied after the irritant, the blend was able to reduce existing UVB irritation by 22% and existing BOP-induced erythema by 28%.
Evaluating electronic visits for remote management of acne: Clinical outcomes are equivalent to conventional care Alice Watson, Massachusetts General Hospital, Boston, MA, United States; Christy Williams, MD, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States; Hagit Bergman, MD, MPH, Massachusetts General Hospital, Boston, MA, United States; Joseph Kvedar, MD, Massachusetts General Hospital, Boston, MA, United States Background: New technologies make it possible to carry out patient care remotely and asynchronously, potentially improving access to specialist dermatology care. The clinical efficacy of such models of care delivery has not previously been evaluated. Methods: We randomized 151 subjects with mild to moderate facial acne to carry out four follow-up visits using either an electronic visit (e-visit) platform or conventional office care. At 6-week intervals, subjects in the e-visit group were prompted to send three digital images of their skin, along with a symptom update, to their dermatologist via a secure Web site. Dermatologists responded with advice and electronic prescriptions within three business days. The primary outcome measure was the change in total inflammatory lesion count between the first and last visit. The aim of the study was to demonstrate equivalence in clinical outcomes. The main secondary outcomes were subject and dermatologist satisfaction with care, and length of time to complete visits.
Commercial support: Sponsored by Clinique Laboratories.
Results: The mean age of subjects was 28 years; the majority were female (78%), white (65%), and college-educated (69%). One hundred twenty-one of the initial 151 subjects completed the study. The change in total inflammatory lesion count was similar in the evisit and office visit groups (6.67 and 9.39, respectively; P ¼.51). Both subjects and dermatologists reported comparable satisfaction with care regardless of modality (P ¼.06 and P ¼.16, respectively). Office visit subjects were more likely to state that a visit took too much time out of their day than e-visit subjects (P\.001). Dermatologists, however, took a similar length of time to complete office and e-visits (4:53 vs 5:08 mins, respectively; P ¼ .5218). Conclusions: Delivering follow-up care to acne patients asynchronously and remotely via an e-visit platform produced equivalent clinical outcomes to conventional office visits. Both patients and physicians expressed high levels of satisfaction with the e-visit platform. Offering e-visits to patients with a range of dermatology conditions may prove to be a convenient way to improve access to specialist care. Commercial support: None identified.
P1702
DIGITAL/ELECTRONIC TECHNOLOGY P1700 Can telemedicine improve health care across the world? Babar Rao, MD, UMDNJ Robert Wood Johnson, Somerset, NJ, United States; Adriana Lombardi, MS, UMDNJ Robert Wood Johnson, Somerset, NJ, United States Objective: To review current literature on telemedicine in developed and developing countries by using teledermatology as an example. Background: Telemedicine is defined as the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or health care provider, and for the purpose of improving patient care. Currently, two types of telemedicine exist; store and forward and real time. Many developed countries, such as the United State,s have made it a priority to incorporate telemedicine into their health care system. Its use in rural areas where shortages of physicians/specialists manifest has improved the convenience and quality of health care. Worldwide, this concept has been adapted by countries in effort to provide better health care for those in rural areas where hospitals may be at a distance and specialists may be even further. Methods: Current literature on telemedicine/teledermatology was reviewed and its efficiency critiqued in attempt to improve dermatologic care in underserved areas. Previous studies and reports have shown that the use of telemedicine—especially teledermatology—has proven to be an inexpensive method for providing care to those whose countries face financial, social, and environmental barriers to adequate health care. Ghana, in western Africa, is an area that faces extreme lack of medical attention and is used as an example for this review because there has been an attempt to use telemedicine to improve health care in this area. To seek medical attention, people must travel by foot to the nearest hospital, which typically serves one-third of the population (23 million people). Various organizations and even private parties have reached out to Africa though the use of telemedicine in efforts to help alleviate the medical catastrophe that the people are currently facing. Currently there is a telemedicine/telehealth project spear-headed in Ghana out of the Dr Martin Luther King Memorial Clinic in Accra, Ghana; a second organization is the African telehealth group. Conclusion: Telemedicine holds great opportunity for relieving inadequate health care in many countries. Although current efforts have positive effects in countries in need, they have not substantially reduced their extreme lack of health care. Countries with inadequate health care must incorporate telemedicine into their health care system through volunteer efforts of doctors in countries worldwide. Teledermatology (store and forward method) is inexpensive and can be easily implemented into the health care system in a developing country. Commercial support: None identified.
AB88
J AM ACAD DERMATOL
A randomized, controlled trial evaluating adherence to sunscreen using electronic monitoring and text message reminders April Armstrong, Massachusetts General Hospital, Boston, MA, United States; Alexandra Kimball, MD, MPH, Massachusetts General Hospital, Boston, MA, United States; Alice Watson, MD, MPH, Center for Connected Health, Massachusetts General Hospital, Boston, MA, United States; Joseph Kvedar, MD, Massachusetts General Hospital, Boston, MA, United States; Maryanne Kazanis, Brigham and Women’s Hospital, Boston, MA, United States Introduction: Low adherence to medications can lead to poor health outcomes and increased health care costs. While most adherence studies have focused on chronic diseases, few have examined strategies to improve adherence to preventive health behaviors. Consistent use of sunscreens is recommended to prevent sunburn and reduce the risk of developing skin cancers. Despite continuing educational efforts, a disconnect persists between public understanding of the harmful effects of excessive sun exposure and regular use of sunscreen. Few innovations exist that accurately measure adherence to topical agents, and no reminder system is currently available to improve sunscreen adherence in the general population. Methods: We developed a reminder service in which subjects were sent text messages to their cellular phones, prompting them to take their medications. The impact of this service was evaluated by conducting a randomized controlled trial assessing adherence rates to sunscreen. All 70 subjects were asked to apply sunscreen daily for 6 weeks. Half of the subjects were randomly assigned to receive text messages via cellular phones, and the other half did not receive reminders. Adherence to daily sunscreen usage was evaluated using a novel electronic monitoring device. Results: Seventy subjects completed the 6-week study. There were no statistically significant differences in baseline characteristics between the two study groups. At the end of the study period, the 35 subjects who did not receive reminders had a mean daily adherence rate of 30.0% (95% CI, 23.1-36.9%). In comparison, the 35 subjects who received daily text message reminders had a mean daily adherence rate of 56.1% (95% CI, 48.1-64.1%; P\.0001). Among the subjects in the reminder group, 68.6% (n ¼ 24) reported that they would keep using the text message reminders after the study, and 88.6% (n ¼ 31) reported that they would recommend the text message reminder system to others. Subgroup analysis did not reveal any significant demographic factors that predicted adherence. Limitations: A longer follow-up period would be required to comment on the longterm effects of text message reminders. While this study used text message reminders to target forgetfulness, many other factors could contribute to nonadherence. Conclusions: Despite awareness of the benefits of sunscreen, adherence is low, even in this population whose adherence was knowingly monitored. Using existing cellular text message technology offers an innovative, low-cost, and effective method of improving adherence to sunscreen. The use of ubiquitous communications technology, such text messaging, may have implications for large-scale public health initiatives. Commercial support: None identified.
MARCH 2009
P1701
Comparative effects of an antiinflammatory blend on reducing skin irritation caused by ultraviolet B light or a chemical irritant to 1% hydrocortisone Donald Collins, Clinique Laboratories, Melville, NY, United States; Chia Chen, Clinique Laboratories, Melville, NY, United States; Daniel Maes, Clinique Laboratories, Melville, NY, United States; Neelam Muizzuddin, Clinique Laboratories, Melville, NY, United States It is of considerable interest to develop a topical agent containing no hydrocortisone (HC) that can both reduce the onset of chemically- or environmentally-induced skin irritation and ameliorate this irritation once it occurs. A blend of ingredients with antiinflammatory activities has been developed that outperforms topical 1% HC with regard to ultraviolet B light (UVB)-induced or balsam of Peru (BOP)-induced skin irritation. This blend contains an inhibitor of histamine release, inhibitors of the PLA2, 5-LO, COX-2, collagenase, elastase, and PDE IV enzymes, neutrophil chemotaxis and adhesion blockers, a histamine receptor blocker, and an inhibitor of nuclear factor kappa beta activation. A cosmetically acceptable oil/water emulsion containing the antiinflammatory ingredients was prepared and applied to human subjects either 20 minutes before exposure to the irritant (UVB or BOP) or after irritant exposure once erythema was achieved. When applied before the irritant, this blend was able to reduce BOP-induced erythema by 82% and UVB-induced erythema by [90%. When applied after the irritant, the blend was able to reduce existing UVB irritation by 22% and existing BOP-induced erythema by 28%.
Evaluating electronic visits for remote management of acne: Clinical outcomes are equivalent to conventional care Alice Watson, Massachusetts General Hospital, Boston, MA, United States; Christy Williams, MD, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States; Hagit Bergman, MD, MPH, Massachusetts General Hospital, Boston, MA, United States; Joseph Kvedar, MD, Massachusetts General Hospital, Boston, MA, United States Background: New technologies make it possible to carry out patient care remotely and asynchronously, potentially improving access to specialist dermatology care. The clinical efficacy of such models of care delivery has not previously been evaluated. Methods: We randomized 151 subjects with mild to moderate facial acne to carry out four follow-up visits using either an electronic visit (e-visit) platform or conventional office care. At 6-week intervals, subjects in the e-visit group were prompted to send three digital images of their skin, along with a symptom update, to their dermatologist via a secure Web site. Dermatologists responded with advice and electronic prescriptions within three business days. The primary outcome measure was the change in total inflammatory lesion count between the first and last visit. The aim of the study was to demonstrate equivalence in clinical outcomes. The main secondary outcomes were subject and dermatologist satisfaction with care, and length of time to complete visits.
Commercial support: Sponsored by Clinique Laboratories.
Results: The mean age of subjects was 28 years; the majority were female (78%), white (65%), and college-educated (69%). One hundred twenty-one of the initial 151 subjects completed the study. The change in total inflammatory lesion count was similar in the evisit and office visit groups (6.67 and 9.39, respectively; P ¼.51). Both subjects and dermatologists reported comparable satisfaction with care regardless of modality (P ¼.06 and P ¼.16, respectively). Office visit subjects were more likely to state that a visit took too much time out of their day than e-visit subjects (P\.001). Dermatologists, however, took a similar length of time to complete office and e-visits (4:53 vs 5:08 mins, respectively; P ¼ .5218). Conclusions: Delivering follow-up care to acne patients asynchronously and remotely via an e-visit platform produced equivalent clinical outcomes to conventional office visits. Both patients and physicians expressed high levels of satisfaction with the e-visit platform. Offering e-visits to patients with a range of dermatology conditions may prove to be a convenient way to improve access to specialist care. Commercial support: None identified.
P1702
DIGITAL/ELECTRONIC TECHNOLOGY P1700 Can telemedicine improve health care across the world? Babar Rao, MD, UMDNJ Robert Wood Johnson, Somerset, NJ, United States; Adriana Lombardi, MS, UMDNJ Robert Wood Johnson, Somerset, NJ, United States Objective: To review current literature on telemedicine in developed and developing countries by using teledermatology as an example. Background: Telemedicine is defined as the use of medical information exchanged from one site to another via electronic communications for the health and education of the patient or health care provider, and for the purpose of improving patient care. Currently, two types of telemedicine exist; store and forward and real time. Many developed countries, such as the United State,s have made it a priority to incorporate telemedicine into their health care system. Its use in rural areas where shortages of physicians/specialists manifest has improved the convenience and quality of health care. Worldwide, this concept has been adapted by countries in effort to provide better health care for those in rural areas where hospitals may be at a distance and specialists may be even further. Methods: Current literature on telemedicine/teledermatology was reviewed and its efficiency critiqued in attempt to improve dermatologic care in underserved areas. Previous studies and reports have shown that the use of telemedicine—especially teledermatology—has proven to be an inexpensive method for providing care to those whose countries face financial, social, and environmental barriers to adequate health care. Ghana, in western Africa, is an area that faces extreme lack of medical attention and is used as an example for this review because there has been an attempt to use telemedicine to improve health care in this area. To seek medical attention, people must travel by foot to the nearest hospital, which typically serves one-third of the population (23 million people). Various organizations and even private parties have reached out to Africa though the use of telemedicine in efforts to help alleviate the medical catastrophe that the people are currently facing. Currently there is a telemedicine/telehealth project spear-headed in Ghana out of the Dr Martin Luther King Memorial Clinic in Accra, Ghana; a second organization is the African telehealth group. Conclusion: Telemedicine holds great opportunity for relieving inadequate health care in many countries. Although current efforts have positive effects in countries in need, they have not substantially reduced their extreme lack of health care. Countries with inadequate health care must incorporate telemedicine into their health care system through volunteer efforts of doctors in countries worldwide. Teledermatology (store and forward method) is inexpensive and can be easily implemented into the health care system in a developing country. Commercial support: None identified.
AB88
J AM ACAD DERMATOL
A randomized, controlled trial evaluating adherence to sunscreen using electronic monitoring and text message reminders April Armstrong, Massachusetts General Hospital, Boston, MA, United States; Alexandra Kimball, MD, MPH, Massachusetts General Hospital, Boston, MA, United States; Alice Watson, MD, MPH, Center for Connected Health, Massachusetts General Hospital, Boston, MA, United States; Joseph Kvedar, MD, Massachusetts General Hospital, Boston, MA, United States; Maryanne Kazanis, Brigham and Women’s Hospital, Boston, MA, United States Introduction: Low adherence to medications can lead to poor health outcomes and increased health care costs. While most adherence studies have focused on chronic diseases, few have examined strategies to improve adherence to preventive health behaviors. Consistent use of sunscreens is recommended to prevent sunburn and reduce the risk of developing skin cancers. Despite continuing educational efforts, a disconnect persists between public understanding of the harmful effects of excessive sun exposure and regular use of sunscreen. Few innovations exist that accurately measure adherence to topical agents, and no reminder system is currently available to improve sunscreen adherence in the general population. Methods: We developed a reminder service in which subjects were sent text messages to their cellular phones, prompting them to take their medications. The impact of this service was evaluated by conducting a randomized controlled trial assessing adherence rates to sunscreen. All 70 subjects were asked to apply sunscreen daily for 6 weeks. Half of the subjects were randomly assigned to receive text messages via cellular phones, and the other half did not receive reminders. Adherence to daily sunscreen usage was evaluated using a novel electronic monitoring device. Results: Seventy subjects completed the 6-week study. There were no statistically significant differences in baseline characteristics between the two study groups. At the end of the study period, the 35 subjects who did not receive reminders had a mean daily adherence rate of 30.0% (95% CI, 23.1-36.9%). In comparison, the 35 subjects who received daily text message reminders had a mean daily adherence rate of 56.1% (95% CI, 48.1-64.1%; P\.0001). Among the subjects in the reminder group, 68.6% (n ¼ 24) reported that they would keep using the text message reminders after the study, and 88.6% (n ¼ 31) reported that they would recommend the text message reminder system to others. Subgroup analysis did not reveal any significant demographic factors that predicted adherence. Limitations: A longer follow-up period would be required to comment on the longterm effects of text message reminders. While this study used text message reminders to target forgetfulness, many other factors could contribute to nonadherence. Conclusions: Despite awareness of the benefits of sunscreen, adherence is low, even in this population whose adherence was knowingly monitored. Using existing cellular text message technology offers an innovative, low-cost, and effective method of improving adherence to sunscreen. The use of ubiquitous communications technology, such text messaging, may have implications for large-scale public health initiatives. Commercial support: None identified.
MARCH 2009