375 Understanding the effectiveness, utilization and perceptions of action plans in adults and caregivers of children with atopic dermatitis
Authors: Johnson Jessica K , Loiselle Allison R , Begolka Wendy Smith 
Published: June 2023

Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin condition with heterogeneous symptoms that can change in both frequency and severity. Treatment regimens may need to be adjusted accordingly. An eczema action plan (EAP) is a personalized set of instructions that provides guidance to patients on which actions to take when eczema symptoms worsen.The impact of action plans (AP) has been researched primarily among asthma patients and have shown to be effective in increasing self-management of chronic disease. Given the similarities between asthma and AD's stepwise treatment approaches and the potential for disease flares, the use of APs for eczema may help to foster alignment and adherence to agreed upon treatment regimens, as well as care satisfaction and outcomes. Little is known about the current use of EAPs in the management of AD. This study aims to assess the awareness, utilization and effectiveness of EAPs in the management of AD from the perspective of patients with AD and caregivers. Adult patients with AD (18+ years) or caregivers of pediatric patients with AD (0–17 years) were recruited to complete a survey about experiences with EAPs in the past 12 months. Responses from 443 adults and 121 caregivers met inclusion criteria. Patients were primarily female (62.2%) and most frequently reported their eczema symptoms as moderate (39.6%). Overall, use of EAP in care management was low. In total, 39.3% (n = 217) of respondents had heard of EAPs. Of those, 59.9% (n = 130) had received one from their primary eczema provider in the past 12 months, and 17.1% (n = 37) had received one prior to the past 12 months. Caregivers were more likely to have heard of an EAP than adult patients (52.3% vs. 36.1%, P &lt; 0.001), but were equally likely to have received one (76.2% vs. 78.9%). Neither eczema severity nor the number of times a provider was seen was associated with receipt of an EAP. For those who had used an EAP in the past 12 months, 66.1% (n = 109) found it helpful/very helpful overall, and 59.1% (n = 94) said it helped them to effectively follow their treatment plan often/almost always. In fact, 89.6% of respondents said they had referred to the EAP one or more times outside of their scheduled visits with their provider. Those who found their EAP to be somewhat/not very/not helpful at all (n = 99) most often reported that a more individualized plan (20.2%; n = 20) or more instruction on how to use the AP (18.2%; n = 18) would have made it more helpful. Additionally, 10.4% said that they had never modified it with their provider. While the use of EAP in clinical care is not widespread, the ability of EAPs to enhance AD self-management and treatment maintenance is promising. There is opportunity to improve EAP use, education and utility through additional patient personalization and increased provider instruction. Future work should examine a more in-depth understanding of healthcare provider perceptions and frequency of EAP use, and the extent to which a patient or caregiver is involved in the conception of the EAP.