Monday, February 14, 2022

Attacking Mechanisms in Atopic Dermatitis — Tethered Learning to Simultaneously Address Clinician and Patient Educational Gaps

By: Mike LoPresti

Read the full case study from the Alliance 2022 Award for Excellence in Educational Design recipient.

Introduction and Summary

In September 2020, Med-IQ launched multiple educational activities for healthcare providers (HCPs) diagnosing and treating moderate-to-severe atopic dermatitis (AD) and strategically aligned patient education activities for patients suffering from uncontrolled AD and their caregivers. The educational design of this program was notable for a number of reasons, including:

Patient education was delivered and disseminated through an influencer-driven social media campaign
Associated specialist and primary care education focused on strategic inflection points along the patient journey
Patient-focused program data and feedback were incorporated into the HCP education to provide a timely and relevant patient perspective.

HCP and patient response to the initiative has been tremendous, and similar programs are being deployed in other disease states.

Educational Design

The design of the overall program emerged from findings uncovered through standard research means used for needs assessments, discussions with patients and providers around their perceptions and experiences with successes and failures in treating moderate-to-severe AD, and input from an important collaborator, the National Eczema Association (NEA), an influential patient advocacy group that provided strong representation of its patient-members’ needs and challenges.

With these methods, three core needs and gaps became clear:

Identified Need	Patient/Practice Gap
Patients with uncontrolled moderate-to-severe AD are not receiving the most effective care from their primary HCPs.	These patients need to be armed with credible information to support reevaluation of their AD severity and referral to a dermatology specialist when appropriate.
Primary HCPs are inaccurately measuring AD severity and are unaware that their patients with more severe disease may have immune-mediated causes.	Primary HCPs must consider multiple factors when assessing AD severity and the potential need for treatment changes and more advanced specialist care.
Dermatology HCPs may not be up to date on current knowledge on the primary drivers of the inflammatory response behind moderate-to-severe AD and new and emerging target therapies for adult and pediatric patients.	Specialist HCPs should be familiar with current science around moderate-to-severe AD as an immune-mediated (autoimmune) disease, as well as how to incorporate new and emerging targeted therapies into individual treatment plans.

Addressing Gaps From 2 Directions Simultaneously

Based on these findings, Med-IQ’s team decided that attempting to improve care for patients with moderate-to-severe AD would have a much greater chance of success if education addressed the needs of both patients/caregivers and their HCPs simultaneously, and all patient and HCP educational messaging was carefully aligned.

To achieve this alignment, Med-IQ mapped out the typical patient journey (uncovered during needs assessment research and confirmed by NEA) and the route of optimal patient care (as defined by topic experts and various treatment guidelines). These two pathways were compared in parallel and three key inflection points which would ultimately drive the program objectives and goals were identified. The result of this exercise is shown below.

After completing this analysis, the following deliverables were selected. Each focused on one or more of the identified target audiences and were designed to address the proposed program goals.

Audience	Deliverables	Goal
Patients	Med-IQ Social™ multi-component education campaign delivered via social media	Empower patients with uncontrolled moderate-to-severe AD to seek reevaluation of their disease severity and referral to a specialist as appropriate
HCPs in primary care, pediatrics and dermatology	Certified Med-IQ Medical Insiders™ online activity with patient survey data from the patient education	Drive primary care and pediatric clinicians to reevaluate patients for severe disease and refer when appropriate
Dermatology specialist HCPs	Certified Med-IQ Select™ online modular activity with Osmosis™ whiteboard-style animations	Drive specialists to consider (new) systemic therapies for uncontrolled moderate-to-severe AD

Med-IQ collaborated with NEA prior to grant submission to finalize educational needs and how they would be addressed by the objectives of the initiative; following approval, we engaged faculty to review the plan and they made no changes. For the social media campaign, we had a meeting with the influencer team together with an NEA representative and activity faculty, Drs. Peter Lio (Northwestern University Feinberg School of Medicine) and Elaine Siegfried (Saint Louis University School of Medicine), to review key points for the patient education and enable the influencer team to ask questions of the physician experts, ensuring we successfully addressed our program objectives.

Assessment and Evaluation

While assessment of program impact for the clinician activities was relatively standard and straightforward, the patient education delivered through social media channels added significant complexity, both for measurement of each individual component and for evaluating how the patient education affected the overall initiative. Metrics collected and analyzed for social media education are radically different from those for clinician education and need to be analyzed through a different lens. Also, data collected through a patient survey was incorporated into the clinician education to emphasize patient needs and preferences. The impact of this survey data on clinicians was a valuable measurement, as was the discordance uncovered between clinician and patient perspectives on the effect of moderate-to-severe AD on patients’ quality of life.

Initiative Metrics and Outcomes

Patient Education (Target Audience: Patients With AD and Their Caregivers)

Patient education was included a live and archived “Ask the Expert” Facebook Live session, a patient survey and 147 separate pieces of social media content promoted by a team of 10 influencers and launched in September 2020.

The Med-IQ Social campaign achieved:

A potential reach of 2,200,000 impressions
An actual reach of 339,500+ impressions (15% of the total audience),
22,200+ engagements (measured in likes, comments, saves, shares, etc.)
1,102 survey responses.

Qualitative patient comments and feedback from social media and quantitative survey results provided strong indications of the program’s positive impact.

Clinician Education (Target Audiences: HCPs in Primary Care, Pediatrics and Dermatology)

Since its launch on Dec. 20, 2020, more than 1,700 HCPs from targeted specialties have participated in the online activity, “Easing the Burden of Moderate-to-Severe Atopic Dermatitis: Assessing Severity, Targeting Pathways and Improving Quality of Life.” Meanwhile, 995 HCPs have participated in the specialist-focused online activity, “Attacking the Mechanisms of Moderate-to-Severe Atopic Dermatitis With Targeted Therapy.” For each, improvement in knowledge and commitment to change were collected and analyzed (see appendix for more information).

Analysis of Integrated Patient-Clinician Education

Related questions intended to uncover learners’ perceptions of specific key quality-of-life issues for patients with AD were asked of both patients/caregivers (e.g., “How does AD affect your/your child’s…”) and HCPs (e.g., “How do you think AD affects your patients’…”). Responses were compared and areas of discordance identified for addressing in future education.

A Model for Excellence in Educational Design

As medical educators, we often encounter challenges that demand knowledge gain and/or behavior change by both HCPs and patients to achieve substantial improvement in patient care. Educational design that incorporates, aligns and integrates education for both HCPs and patients may drive change from both sides of the clinician-patient relationship. Educated and empowered patients may more confidently participate in shared decision-making, while educated clinicians who better understand their patients’ perspectives, needs and preferences are more likely to engage these patients in active, individualized discussions about their care.

Lessons Learned, Modifications for Future Programs

Because the world of social media is distinctly different from the familiar environs of CME/CE, training of the commercial supporters’ CME departments on the unique vernacular of social media was critical to clarifying the purpose of each deliverable and the uptake and value of the program. Conducting this training before the launch of the program would have expedited metrics and outcomes presentations and facilitated understanding.

Another important realization was the lack of planned methods for quantitatively measuring the impact of the patient education on patient behavior (or planned behavior). For similarly designed initiatives in 2021–2022, Med-IQ has included methods for improving longitudinal patient engagement and measurement after participating in one or more components of the patient education. Med-IQ hopes to report on the success of these new additions to its Med-IQ Social patient education platform at a later date.