E-health in caring for patients with atopic dermatitis. An economic evaluation comparing usual care with
Internet-guided monitoring and self-management training by a nurse practitioner.

The problem investigated in this proposal is the inefficiency of scheduled visits for patients with atopic dermatitis (AD) and parents of young children with AD. The subject of the study is an economic evaluation comparing usual care with e-health consisting of internet guided monitoring and self-management training by a nurse practitioner(NP) using a personal
website. It is expected that the proposed intervention combines cost savings with an improvement in quality of life.
In a randomized controlled trial e-health for adults and parents of young children with AD will be compared with usual care, consisting of scheduled follow-up visits to the dermatologist and the dermatology nurse practitioner.
Primary outcome measures are direct and indirect costs of care (fixed costs of e-health service; out-patient visits; days off work by adult patients and the parents of patients with AD) and Quality of Life.
Secondary parameters are patient satisfaction and severity and extensiveness of the AD. Data-analysis will take place at three moments (baseline, after 3 and 12 months). Based on the power calculation two times 100 patients will be sufficient. The balance between costs and effects will be addressed using a multi-criteria analysis representing all outcomes and costs for both adults and parents of children. The total duration of the project is three years: patient inclusion 1,5 year, continuation 1
year and processing data 0,5 year.

We hypothesize that e-health, consisting of internet guided monitoring and self management training online, for patients with atopic dermatitis combines cost savings with an improvement in quality of life.

Intervention group: E-health
E-health consists of Internet guided monitoring and self-management training. Every patient has access to his personal website using a password. The nurse practitioner (NP) has access to this site too.
This personal website contains:
1. General information about atopic dermatitis (AD) and personal information about prescribed treatment and daily skincare;
2. Provides monitoring information. The patient can monitor the disease using digital photographs of the skin, a self score of skin status, VAS-scores of sleeping and itching and by keeping a diary of ointment use. The NP uses the data to support patients or parents in self management by e-mail;
3. Offers the possibility for E-mail contact between the patient and NP on all working days;
4. Facilitates an assessment of psychosocial aspects and consequences of having AD for daily living. The NP can counsel, give information or advice in individual cases.
Follow-up visits to the NP or dermatologist are possible in individual cases where e-health is inadequate.
The control group receives the usual care consisting of scheduled follow-up visits to the dermatologist and the dermatology nurse practitioner.