Patient reported outcomes in chronic skin diseases: eHealth applications for clinical practice

The overall aim of this thesis was to examine and integrate patient reported outcomes (PROs) in dermatological care. In part I, we specifically examined health-related quality of life (HRQoL), treatment satisfaction, and experiences with care in patients with chronic skin diseases. Our results indicated that patients with a chronic skin disease experienced an impaired HRQoL, were only moderately satisfied with their treatment, although satisfaction among psoriasis patients varied across treatment types, and were generally positive about their care. Based on our results, we made several suggestions to improve quality of care, for instance to focus on improving doctor-patient communication and information provision.
In part II, we developed and tested two eHealth applications to integrate PROs in dermatological practice: 1) PROM portal Dermatology, a web-based application to electronically assess PROs in dermatological practice, and 2) E-learning Quality of Life, a web-based, educational, HRQoL intervention for patients with a chronic skin disease. Our results indicated that the two eHealth applications are relevant in the opinion of important stakeholders. However, implementation in clinical practice and patients’ daily life remains difficult. To optimize implementation, we recommend an implementation process involving all stakeholders using a plan-do-study-act approach. Reflecting on our main findings, we proposed a stepped care model to integrate PROs in clinical dermatological practice and provide patients with appropriate care. Also, we offered suggestions for future research and clinical practice.