2026 Eastern States Conference

Title: Assessing atopic eczema severity through patient-reported outcomes: the role of the specialty pharmacist in bridging treatment gaps at a rural health system

Authors: Alexander J. Vose, Gabrielle N. Plaia; Dartmouth-Hitchcock Medical Center, Lebanon, NH

Learning Objective: Recognize the capacity of the pharmacist to coordinate care through the use of a patient reported outcomes questionnaire (POEM).

Background/Objectives: Rural health centers face gaps in atopic dermatitis care. By using the POEM tool, pharmacists can remotely monitor symptoms, triage issues, and optimize therapy. This improves outcomes, reduces urgent visits, and highlights pharmacist value.

Background: Specialty pharmacy medications aim to improve quality of life in chronic conditions such as atopic dermatitis. At our rural health center, a gap exists between when a patient with atopic dermatitis is given treatment and when efficacy is assessed. It is especially necessary to engage these patients in between visits given barriers to in-person care. Specialty pharmacists are able to provide a solution by utilizing patient-reported outcome measures through the Patient Oriented Eczema Assessment (POEM) which monitors the patient experience with eczema in a timely fashion. Leveraging the pharmacist to administer the POEM can help to bridge this gap by improving patient care and outcomes.

Objectives: Given the costs associated with patient’s over and/or underutilization of provider services, the POEM score will better provide clarity on which patients require care from a provider in clinic and those who do not. With implementation of the POEM tool, patients can self-report symptoms and initiate pharmacist intervention if necessary. Pharmacists can triage issues to alert clinics as needed, allowing providers to see patients sooner if their therapy is ineffective. This generates more timely interventions to better optimize therapy and prevents patients from having severe symptom flare ups. Integrating the POEM tool into workflow leverages pharmacists’ skills, improves patient reported outcomes, and lowers the need for urgent or acute visits while justifying the value of pharmacist-provided services.

Methods: The Patient Oriented Eczema Measure (POEM) questionnaire was offered to eligible patients with an atopic dermatitis diagnosis at baseline, defined as two weeks before or two weeks after starting specialty treatment. Patients conducted this assessment either during clinic visit, via telephone, or by filling out a questionnaire sent directly to them in the electronic medical record (EMR). The pharmacist then followed up 3-4 months after starting therapy to re-assess symptoms via the questionnaire. Patients must be ≥ 6 months of age and treated through collaborative services between a DH Dermatology Clinic and DH Specialty Pharmacy for atopic dermatitis. Additionally, patients must be able to read and comprehend the questions included on the POEM either themselves or by proxy.

Results: 30 patients were enrolled and 12 completed both the initial and follow-up questionnaire. 13 patients were lost to follow up due to insurance mandates, three patients did not start therapy, and two patient discontinued therapy. Implementation of the POEM tool led to a reduction in scores for almost all (91.7%) of patients at follow-up. The average POEM score at baseline was 18.5 (range 7-28) and the average POEM score at follow-up was 5.5 (range 0-24). This indicates a decrease in symptom frequency and severity. One patient was referred back to their dermatologist for a therapy change due to pharmacist-identified increase in POEM score.

Conclusion: The POEM tool and associated pharmacist-led monitoring can aid in therapy optimization and bridge gaps in assessing efficacy of atopic dermatitis treatment. The role of the pharmacist in this model enhances outcomes and ensures appropriate utilization of provider services. Integration of this workflow can be translated to other chronic conditions to improve therapy management and can potentially reduce burden on acute care serves.

Self-Assessment Question: Which monitoring questionnaire could pharmacists utilize to assess therapy efficacy in atopic dermatitis?
a. MIDAS
b. RAPID-3
c. POEM
d. SIBDQ