Improvement of documentation of the Total Steroid Burden and education of steroid effect in Atopic Dermatitis with the use of a simplified EMR tool
Winthrop University Hospital
Atopic dermatitis (AD) is a common, chronic allergic-dermatologic disorder affecting up to 10-20% of children and 1-3% of adults, with an estimated economic impact of up to $3.8 billion dollars per year. Corticosteroids are judiciously used in the medical arena for various disease processes, especially in disorders of “atopy.”3 Allergists and immunologists, dermatologists, and primary care physicians prescribe several types of corticosteroids (topical, intranasal, inhaled, and systemic) and some patients may self-treat with topical or intranasal corticosteroids. This is common especially since many of these steroid preparations are available over the counter to treat protean conditions including atopic dermatitis, eczema, rhinitis, and asthma. Moreover, there is data suggesting that AD patients may be over-prescribed high potency topical as well as systemic corticosteroids.4 However, monitoring of the total steroid burden is usually considered cumbersome, and its importance is often overlooked by both the patient and the practitioner. As such, side effects, subtle and obvious, local and systemic are not monitored.3 The education of patients as well as caretakers of pediatric patients with AD is highly recommended to decrease health care associated costs and improve the overall delivery of health care and quality of life in this patient population.5-6
The overall goal of this QI project for AD patients is to complete clinical practice utilization of a monitoring tool for total steroid burden (systemic, cutaneous, intranasal and inhaled) with appropriate and compliant health record documentation. This monitoring tool was recently published by members of our Allergy/Immunology group.
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Quality Improvements in AD