“What am I allowed to do?” radiation oncologist Vivek Kavadi, MD, asked the business manager at Texas Oncology in Sugar Land, Tex.

Dr. Kavadi wanted to give his patient with early-stage breast cancer a standard radiation treatment – hypofractionated 3D conformal radiation therapy – following her lumpectomy.

But his hands were tied.

Dr. Kavadi had submitted a prior authorization request, but the patient’s health insurance was dragging its feet. And without prior authorization, Dr. Kavadi couldn’t schedule his patient’s first treatment.

“I chose the most cost-effective, standard treatment, but nothing could begin without the insurance company’s permission,” he said.

One of the most challenging aspects of the delay was explaining to his patient why he couldn’t schedule her treatment. “We would love to start, but your insurance company has not given us approval. The best I can do is give you a tentative appointment,” he recalled telling her.

After a few days with no word, calls to the insurance company began. “My patient called, I called, my office called,” Dr. Kavadi said. “It was a week or more of aggravation, stress, and time wasted for my patient and my team.”

This type of delay has become increasingly common in radiation oncology. One recent analysis estimated that 97% of radiation oncology services now require prior authorization under Medicare Advantage. And another analysis found that almost all radiation oncologists said prior authorization delays life-saving care for their patients.

The rise of prior authorization requirements may boil down to the fact that prior authorization is no longer reserved for uncertain or high-cost care. Terrence Cunningham, director of administrative simplification policy for the American Hospital Association, told this news organization last year that “prior authorization used to be applied only to new, costly, or high-risk services,” but now “many insurers require authorizations for even routine care, which is inappropriate.”

The growth of prior authorization requirements has forced many doctors, nurses, and pharmacists to dedicate part of their workday to handling requests and appealing denials and has forced many practices to hire staff exclusively for prior authorizations.

This additional work is costly.

One recent study found that the radiation oncology department of Vanderbilt University, Nashville, Tenn., spent nearly $500,000 annually in employee time to obtain prior authorization for radiation therapy treatments. Extrapolated nationally, the researchers estimated that physicians’ annual compensation for prior authorization duties came to an estimated $46 million. Overall, 86% of these costs were for treatments that were ultimately approved, the majority on initial request and some on appeal.

Dr. Kavadi has five full-time employees dedicated to managing prior authorization requests and challenges.

And after a week of delays and hours on the phone with the insurer, his patient’s radiation treatment was ultimately approved.

Dr. Kavadi wondered why something so simple needed to be so onerous.

Stretching out an approval for a standard radiation treatment “feels like a means of intentionally delaying care,” Dr. Kavadi said. “This is an example of a process that has run so far amok. It’s just a burden across the board.”

And even with his 30 years of experience, “I still have to ask my business supervisor what I am allowed to do,” he said. “I can’t just proceed with what’s best for my patient, what the patient has consented to, and what also happens to be the least expensive option.”

A version of this article first appeared on Medscape.com.

“What am I allowed to do?” radiation oncologist Vivek Kavadi, MD, asked the business manager at Texas Oncology in Sugar Land, Tex.

Dr. Kavadi wanted to give his patient with early-stage breast cancer a standard radiation treatment – hypofractionated 3D conformal radiation therapy – following her lumpectomy.

But his hands were tied.

Dr. Kavadi had submitted a prior authorization request, but the patient’s health insurance was dragging its feet. And without prior authorization, Dr. Kavadi couldn’t schedule his patient’s first treatment.

“I chose the most cost-effective, standard treatment, but nothing could begin without the insurance company’s permission,” he said.

One of the most challenging aspects of the delay was explaining to his patient why he couldn’t schedule her treatment. “We would love to start, but your insurance company has not given us approval. The best I can do is give you a tentative appointment,” he recalled telling her.

After a few days with no word, calls to the insurance company began. “My patient called, I called, my office called,” Dr. Kavadi said. “It was a week or more of aggravation, stress, and time wasted for my patient and my team.”

This type of delay has become increasingly common in radiation oncology. One recent analysis estimated that 97% of radiation oncology services now require prior authorization under Medicare Advantage. And another analysis found that almost all radiation oncologists said prior authorization delays life-saving care for their patients.

The rise of prior authorization requirements may boil down to the fact that prior authorization is no longer reserved for uncertain or high-cost care. Terrence Cunningham, director of administrative simplification policy for the American Hospital Association, told this news organization last year that “prior authorization used to be applied only to new, costly, or high-risk services,” but now “many insurers require authorizations for even routine care, which is inappropriate.”

The growth of prior authorization requirements has forced many doctors, nurses, and pharmacists to dedicate part of their workday to handling requests and appealing denials and has forced many practices to hire staff exclusively for prior authorizations.

This additional work is costly.

One recent study found that the radiation oncology department of Vanderbilt University, Nashville, Tenn., spent nearly $500,000 annually in employee time to obtain prior authorization for radiation therapy treatments. Extrapolated nationally, the researchers estimated that physicians’ annual compensation for prior authorization duties came to an estimated $46 million. Overall, 86% of these costs were for treatments that were ultimately approved, the majority on initial request and some on appeal.

Dr. Kavadi has five full-time employees dedicated to managing prior authorization requests and challenges.

And after a week of delays and hours on the phone with the insurer, his patient’s radiation treatment was ultimately approved.

Dr. Kavadi wondered why something so simple needed to be so onerous.

Stretching out an approval for a standard radiation treatment “feels like a means of intentionally delaying care,” Dr. Kavadi said. “This is an example of a process that has run so far amok. It’s just a burden across the board.”

And even with his 30 years of experience, “I still have to ask my business supervisor what I am allowed to do,” he said. “I can’t just proceed with what’s best for my patient, what the patient has consented to, and what also happens to be the least expensive option.”

A version of this article first appeared on Medscape.com.

“What am I allowed to do?” radiation oncologist Vivek Kavadi, MD, asked the business manager at Texas Oncology in Sugar Land, Tex.

Dr. Kavadi wanted to give his patient with early-stage breast cancer a standard radiation treatment – hypofractionated 3D conformal radiation therapy – following her lumpectomy.

But his hands were tied.

Dr. Kavadi had submitted a prior authorization request, but the patient’s health insurance was dragging its feet. And without prior authorization, Dr. Kavadi couldn’t schedule his patient’s first treatment.

“I chose the most cost-effective, standard treatment, but nothing could begin without the insurance company’s permission,” he said.

One of the most challenging aspects of the delay was explaining to his patient why he couldn’t schedule her treatment. “We would love to start, but your insurance company has not given us approval. The best I can do is give you a tentative appointment,” he recalled telling her.

After a few days with no word, calls to the insurance company began. “My patient called, I called, my office called,” Dr. Kavadi said. “It was a week or more of aggravation, stress, and time wasted for my patient and my team.”

This type of delay has become increasingly common in radiation oncology. One recent analysis estimated that 97% of radiation oncology services now require prior authorization under Medicare Advantage. And another analysis found that almost all radiation oncologists said prior authorization delays life-saving care for their patients.

The rise of prior authorization requirements may boil down to the fact that prior authorization is no longer reserved for uncertain or high-cost care. Terrence Cunningham, director of administrative simplification policy for the American Hospital Association, told this news organization last year that “prior authorization used to be applied only to new, costly, or high-risk services,” but now “many insurers require authorizations for even routine care, which is inappropriate.”

The growth of prior authorization requirements has forced many doctors, nurses, and pharmacists to dedicate part of their workday to handling requests and appealing denials and has forced many practices to hire staff exclusively for prior authorizations.

This additional work is costly.

One recent study found that the radiation oncology department of Vanderbilt University, Nashville, Tenn., spent nearly $500,000 annually in employee time to obtain prior authorization for radiation therapy treatments. Extrapolated nationally, the researchers estimated that physicians’ annual compensation for prior authorization duties came to an estimated $46 million. Overall, 86% of these costs were for treatments that were ultimately approved, the majority on initial request and some on appeal.

Dr. Kavadi has five full-time employees dedicated to managing prior authorization requests and challenges.

And after a week of delays and hours on the phone with the insurer, his patient’s radiation treatment was ultimately approved.

Dr. Kavadi wondered why something so simple needed to be so onerous.

Stretching out an approval for a standard radiation treatment “feels like a means of intentionally delaying care,” Dr. Kavadi said. “This is an example of a process that has run so far amok. It’s just a burden across the board.”

And even with his 30 years of experience, “I still have to ask my business supervisor what I am allowed to do,” he said. “I can’t just proceed with what’s best for my patient, what the patient has consented to, and what also happens to be the least expensive option.”

A version of this article first appeared on Medscape.com.

The first day of seeing patients without a mask was, for Sterling Ransone Jr., MD, “unsettling.” 

“I can’t tell you how weird it was the first day that I walked down the hall from my office to where my exam rooms are, to not have a mask on after 3 years of the habit,” said Dr. Ransone, a family physician in Deltaville, Va., and board chair of the American Academy of Family Physicians. 

The White House recently lifted the public health emergency order that overhauled the way health care providers operated and advised patients over the past 3 years. The new postpandemic era will require clinicians and staff to once again adjust. 

For Dr. Ransone, this transition entails getting used to his bare face, reminding patients of the latest and varying symptoms of the virus, and parting ways with sick patients if they refuse to wear a mask.

As states, hospitals, and health care systems around the country relax their mask mandates for care providers, clinicians will have to fall back on their own policies that patients with potential symptoms mask up. 

“Now that it’s up to our offices, we have to have a little bit more backbone,” Dr. Ransone said. “If they’re not willing to follow a health-related policy that will protect the vulnerable, we will not see them. And so for us, it’s been pretty straightforward.”

Despite the policy, Dr. Ransone has cared for patients who don’t disclose they are feeling sick until he enters the room. 

“And I wasn’t masked,” Dr. Ransone said. So, “I will wear masks for the rest of the day just to try to protect the rest of my patients in case I was exposed.”

Masks are optional for both patients and staff at the University of Maryland Medical System, but Niharika Khanna, MD, MBBS, said she still wears one with her patients, and her office advises staff to do the same. If patients are experiencing respiratory symptoms, like a cough, they are asked to wear one. 

“When the patient first walks up to you, you have no idea what they have,” Dr. Khanna said. 

Dr. Khanna is especially mindful of immunocompromised patients who have cancer, and Dr. Ransone cares for several patients who have received kidney transplants and are on potent immunosuppressive drugs. 

“I know they’re appreciating our efforts to protect them, and I think the other patients are realizing that it’s a wise thing to do,” Dr. Ransone said. 

Some patients have anxiety about the end of masking in doctor offices, but others have been excited about interacting more with their care teams, according to William Dahut, MD, chief scientific officer for the American Cancer Society. Many clinicians will advise their most immunocompromised patients the same as they did prior to the COVID-19 pandemic. 

“There’s always been guidelines that oncologists have given to patients who are immunocompromised – we always told them to avoid crowded places, crowded scenes, be outside more than inside,” Dr. Dahut said. “Those general recommendations will continue.”

The AAFP supports masking to limit COVID’s spread, but the “most important thing people can do is to get vaccinated,” Tochi Iroku-Malize, MD, MPH, MBA, president of the AAFP, said.

But the accessibility of vaccinations is also shifting.
 

Testing shifts

The government will continue to provide free COVID-19 vaccines because it still has supplies on hand. When this stock runs out, commercial insurance providers will be required to cover the immunizations, as they are considered preventive, but people without insurance will have to pay out of pocket. 

The AAFP is pushing the Biden administration and Congress to keep the purchase price of those vaccines low enough that clinicians can keep them in stock, according to Dr. Iroku-Malize. Once the federal government transitions COVID-19 vaccines to the commercial market – as early as later in 2023 – it may pose some challenges for providers. 

“If the price of the vaccines is too high, physician practices may struggle to make the upfront investment in COVID-19 vaccines,” Dr. Iroku-Malize said. “Patients often prefer to receive vaccine counseling and administration from their usual source of primary care, like their family physician.” 

The federal government has also said it still has a supply of treatments for the public to access for free, but has not revealed how much it has on hand or given a timeline for the transition to the private market. 

COVID-19 tests, meanwhile, are no longer covered because of the end of the public health emergency, and cost about $45 per kit on average, according to an analysis by the Kaiser Family Foundation.

Pediatrician Lisa Costello, MD, MPH, knows that price point will be a challenge for some families she cares for at West Virginia University Medicine Children’s Hospital in Morgantown. Many still ask her where they can access free tests. 

“Testing if you’re a higher risk person is something we need to ensure that people continue to be educated about,” Dr. Costello said. 

She’s hopeful that COVID-19 vaccines and treatments such as Paxlovid will stay free in the coming months so patients can continue to easily access them.
 

Future of telehealth

Relaxed regulations of prescribing controlled substances via telehealth and across state lines allowed clinicians to treat patients near and far during the pandemic. But many providers were worried about a proposal from the Drug Enforcement Administration to clamp down on the prescribing of controlled substances via telehealth, according to A. Mark Fendrick, MD, an internal medicine physician at the University of Michigan, Ann Arbor.

“We were all panicking about what was going to happen to what is for many clinicians a very valuable policy,” Dr. Fendrick said of the telehealth flexibilities introduced during COVID-19. 

The DEA, after getting 38,000 comments on their proposed regulations, pulled back on that plan, delaying the cliff until November. 

Dr. Fendrick said that telehealth has allowed clinicians to reach patients who have historically faced barriers to care, such as lacking transportation. 

“The benefits of that outweigh the potential harms,” he said. “Every policy you make that tightens access because you want to decrease the untoward and unfortunate outcomes will also decrease access to clinical indications.”

The AAFP said it hopes for clear guidance from the DEA in the coming months on what the new telehealth landscape for prescribing will look like.
 

Medicaid changes

About half of the patients who see Dr. Khanna have insurance through Medicaid. 

During the public health emergency, states were not allowed to remove anyone from Medicaid, regardless of whether they no longer qualified for the program or not. But a law passed by Congress last year requires states to once again check Medicaid eligibility. As many as 15 million people could lose their Medicaid coverage. 

That could affect the treatments Dr. Khanna recommends for her patients who get kicked off because those who become uninsured or transition to private insurance will have to pay more out of pocket. Maryland will start removals in June. 

“When you have an uninsured patient versus Medicaid, it’s a huge difference in what you can ask the patient to do – the medications you can provide, the testing you can provide,” Dr. Khanna said. 

States were authorized to remove people from Medicaid as of April 1, with Arkansas, New Hampshire, and South Dakota starting right away. But many states are just now getting the review process going. About a dozen states, including Indiana, Ohio, Utah, and West Virginia, started removing people in May 2023. 

Uninsurance rates hit record lows across the United States during the pandemic. Keeping Americans on health insurance is a top priority for the AAFP, Dr. Iroku-Malize said. “We know health care coverage disruptions prevent people from seeking and accessing the care they need.”

Many people who are removed from Medicaid will be eligible for health insurance through employers, or through the Affordable Care Act’s private marketplace. But premiums and deductibles are often higher in these plans, which studies have shown result in patients delaying medical visits and not filling prescriptions or receiving treatment.
 

Staying mindful

Hospitals that receive federal funds will still have to report COVID-19 test results to the Centers for Medicare & Medicaid Services through 2024, although private labs will no longer be obligated to do so. The Centers for Disease Control and Prevention will also continue to monitor virus levels in communities through wastewater. But some states will no longer collect data. 

Gone are the days when clinicians and others would watch for daily totals of case counts with the type of fervor typically reserved for live scoring updates during sports games, according to Dr. Costello.

“We just have to be mindful of the numbers that might be coming in,” Dr. Costello said.

Dr. Ransone, however, cautioned that clinicians not become complacent. In early May, Dr. Ransone saw two patients with conjunctivitis, what patients thought was simply pink eye – a symptom of the latest COVID-19 variant. Both patients told him it wasn’t possible they had COVID-19 because they didn’t have coughs. 

“I don’t want to see physician offices fall into that trap that it’s over and be a potential nidus for infection for other patients,” Dr. Ransone said. “It’s incumbent upon us to remind people of the current symptoms so that folks will know when they need to wear a mask when they’re around their grandmother.”

The move away from universal masking in the office has benefits. Many of his older patients have difficulty hearing and had used lip reading to help understand him, he said. During the pandemic, masks got in the way of that form of communication. Now they can see his mouth again and better decipher what he says.

“Being able to have that face-to-face contact, without a mask intervening, has been really beneficial for a lot of my older patients,” he said.

A version of this article first appeared on Medscape.com.

The first day of seeing patients without a mask was, for Sterling Ransone Jr., MD, “unsettling.” 

“I can’t tell you how weird it was the first day that I walked down the hall from my office to where my exam rooms are, to not have a mask on after 3 years of the habit,” said Dr. Ransone, a family physician in Deltaville, Va., and board chair of the American Academy of Family Physicians. 

The White House recently lifted the public health emergency order that overhauled the way health care providers operated and advised patients over the past 3 years. The new postpandemic era will require clinicians and staff to once again adjust. 

For Dr. Ransone, this transition entails getting used to his bare face, reminding patients of the latest and varying symptoms of the virus, and parting ways with sick patients if they refuse to wear a mask.

As states, hospitals, and health care systems around the country relax their mask mandates for care providers, clinicians will have to fall back on their own policies that patients with potential symptoms mask up. 

“Now that it’s up to our offices, we have to have a little bit more backbone,” Dr. Ransone said. “If they’re not willing to follow a health-related policy that will protect the vulnerable, we will not see them. And so for us, it’s been pretty straightforward.”

Despite the policy, Dr. Ransone has cared for patients who don’t disclose they are feeling sick until he enters the room. 

“And I wasn’t masked,” Dr. Ransone said. So, “I will wear masks for the rest of the day just to try to protect the rest of my patients in case I was exposed.”

Masks are optional for both patients and staff at the University of Maryland Medical System, but Niharika Khanna, MD, MBBS, said she still wears one with her patients, and her office advises staff to do the same. If patients are experiencing respiratory symptoms, like a cough, they are asked to wear one. 

“When the patient first walks up to you, you have no idea what they have,” Dr. Khanna said. 

Dr. Khanna is especially mindful of immunocompromised patients who have cancer, and Dr. Ransone cares for several patients who have received kidney transplants and are on potent immunosuppressive drugs. 

“I know they’re appreciating our efforts to protect them, and I think the other patients are realizing that it’s a wise thing to do,” Dr. Ransone said. 

Some patients have anxiety about the end of masking in doctor offices, but others have been excited about interacting more with their care teams, according to William Dahut, MD, chief scientific officer for the American Cancer Society. Many clinicians will advise their most immunocompromised patients the same as they did prior to the COVID-19 pandemic. 

“There’s always been guidelines that oncologists have given to patients who are immunocompromised – we always told them to avoid crowded places, crowded scenes, be outside more than inside,” Dr. Dahut said. “Those general recommendations will continue.”

The AAFP supports masking to limit COVID’s spread, but the “most important thing people can do is to get vaccinated,” Tochi Iroku-Malize, MD, MPH, MBA, president of the AAFP, said.

But the accessibility of vaccinations is also shifting.
 

Testing shifts

The government will continue to provide free COVID-19 vaccines because it still has supplies on hand. When this stock runs out, commercial insurance providers will be required to cover the immunizations, as they are considered preventive, but people without insurance will have to pay out of pocket. 

The AAFP is pushing the Biden administration and Congress to keep the purchase price of those vaccines low enough that clinicians can keep them in stock, according to Dr. Iroku-Malize. Once the federal government transitions COVID-19 vaccines to the commercial market – as early as later in 2023 – it may pose some challenges for providers. 

“If the price of the vaccines is too high, physician practices may struggle to make the upfront investment in COVID-19 vaccines,” Dr. Iroku-Malize said. “Patients often prefer to receive vaccine counseling and administration from their usual source of primary care, like their family physician.” 

The federal government has also said it still has a supply of treatments for the public to access for free, but has not revealed how much it has on hand or given a timeline for the transition to the private market. 

COVID-19 tests, meanwhile, are no longer covered because of the end of the public health emergency, and cost about $45 per kit on average, according to an analysis by the Kaiser Family Foundation.

Pediatrician Lisa Costello, MD, MPH, knows that price point will be a challenge for some families she cares for at West Virginia University Medicine Children’s Hospital in Morgantown. Many still ask her where they can access free tests. 

“Testing if you’re a higher risk person is something we need to ensure that people continue to be educated about,” Dr. Costello said. 

She’s hopeful that COVID-19 vaccines and treatments such as Paxlovid will stay free in the coming months so patients can continue to easily access them.
 

Future of telehealth

Relaxed regulations of prescribing controlled substances via telehealth and across state lines allowed clinicians to treat patients near and far during the pandemic. But many providers were worried about a proposal from the Drug Enforcement Administration to clamp down on the prescribing of controlled substances via telehealth, according to A. Mark Fendrick, MD, an internal medicine physician at the University of Michigan, Ann Arbor.

“We were all panicking about what was going to happen to what is for many clinicians a very valuable policy,” Dr. Fendrick said of the telehealth flexibilities introduced during COVID-19. 

The DEA, after getting 38,000 comments on their proposed regulations, pulled back on that plan, delaying the cliff until November. 

Dr. Fendrick said that telehealth has allowed clinicians to reach patients who have historically faced barriers to care, such as lacking transportation. 

“The benefits of that outweigh the potential harms,” he said. “Every policy you make that tightens access because you want to decrease the untoward and unfortunate outcomes will also decrease access to clinical indications.”

The AAFP said it hopes for clear guidance from the DEA in the coming months on what the new telehealth landscape for prescribing will look like.
 

Medicaid changes

About half of the patients who see Dr. Khanna have insurance through Medicaid. 

During the public health emergency, states were not allowed to remove anyone from Medicaid, regardless of whether they no longer qualified for the program or not. But a law passed by Congress last year requires states to once again check Medicaid eligibility. As many as 15 million people could lose their Medicaid coverage. 

That could affect the treatments Dr. Khanna recommends for her patients who get kicked off because those who become uninsured or transition to private insurance will have to pay more out of pocket. Maryland will start removals in June. 

“When you have an uninsured patient versus Medicaid, it’s a huge difference in what you can ask the patient to do – the medications you can provide, the testing you can provide,” Dr. Khanna said. 

States were authorized to remove people from Medicaid as of April 1, with Arkansas, New Hampshire, and South Dakota starting right away. But many states are just now getting the review process going. About a dozen states, including Indiana, Ohio, Utah, and West Virginia, started removing people in May 2023. 

Uninsurance rates hit record lows across the United States during the pandemic. Keeping Americans on health insurance is a top priority for the AAFP, Dr. Iroku-Malize said. “We know health care coverage disruptions prevent people from seeking and accessing the care they need.”

Many people who are removed from Medicaid will be eligible for health insurance through employers, or through the Affordable Care Act’s private marketplace. But premiums and deductibles are often higher in these plans, which studies have shown result in patients delaying medical visits and not filling prescriptions or receiving treatment.
 

Staying mindful

Hospitals that receive federal funds will still have to report COVID-19 test results to the Centers for Medicare & Medicaid Services through 2024, although private labs will no longer be obligated to do so. The Centers for Disease Control and Prevention will also continue to monitor virus levels in communities through wastewater. But some states will no longer collect data. 

Gone are the days when clinicians and others would watch for daily totals of case counts with the type of fervor typically reserved for live scoring updates during sports games, according to Dr. Costello.

“We just have to be mindful of the numbers that might be coming in,” Dr. Costello said.

Dr. Ransone, however, cautioned that clinicians not become complacent. In early May, Dr. Ransone saw two patients with conjunctivitis, what patients thought was simply pink eye – a symptom of the latest COVID-19 variant. Both patients told him it wasn’t possible they had COVID-19 because they didn’t have coughs. 

“I don’t want to see physician offices fall into that trap that it’s over and be a potential nidus for infection for other patients,” Dr. Ransone said. “It’s incumbent upon us to remind people of the current symptoms so that folks will know when they need to wear a mask when they’re around their grandmother.”

The move away from universal masking in the office has benefits. Many of his older patients have difficulty hearing and had used lip reading to help understand him, he said. During the pandemic, masks got in the way of that form of communication. Now they can see his mouth again and better decipher what he says.

“Being able to have that face-to-face contact, without a mask intervening, has been really beneficial for a lot of my older patients,” he said.

A version of this article first appeared on Medscape.com.

The first day of seeing patients without a mask was, for Sterling Ransone Jr., MD, “unsettling.” 

“I can’t tell you how weird it was the first day that I walked down the hall from my office to where my exam rooms are, to not have a mask on after 3 years of the habit,” said Dr. Ransone, a family physician in Deltaville, Va., and board chair of the American Academy of Family Physicians. 

The White House recently lifted the public health emergency order that overhauled the way health care providers operated and advised patients over the past 3 years. The new postpandemic era will require clinicians and staff to once again adjust. 

For Dr. Ransone, this transition entails getting used to his bare face, reminding patients of the latest and varying symptoms of the virus, and parting ways with sick patients if they refuse to wear a mask.

As states, hospitals, and health care systems around the country relax their mask mandates for care providers, clinicians will have to fall back on their own policies that patients with potential symptoms mask up. 

“Now that it’s up to our offices, we have to have a little bit more backbone,” Dr. Ransone said. “If they’re not willing to follow a health-related policy that will protect the vulnerable, we will not see them. And so for us, it’s been pretty straightforward.”

Despite the policy, Dr. Ransone has cared for patients who don’t disclose they are feeling sick until he enters the room. 

“And I wasn’t masked,” Dr. Ransone said. So, “I will wear masks for the rest of the day just to try to protect the rest of my patients in case I was exposed.”

Masks are optional for both patients and staff at the University of Maryland Medical System, but Niharika Khanna, MD, MBBS, said she still wears one with her patients, and her office advises staff to do the same. If patients are experiencing respiratory symptoms, like a cough, they are asked to wear one. 

“When the patient first walks up to you, you have no idea what they have,” Dr. Khanna said. 

Dr. Khanna is especially mindful of immunocompromised patients who have cancer, and Dr. Ransone cares for several patients who have received kidney transplants and are on potent immunosuppressive drugs. 

“I know they’re appreciating our efforts to protect them, and I think the other patients are realizing that it’s a wise thing to do,” Dr. Ransone said. 

Some patients have anxiety about the end of masking in doctor offices, but others have been excited about interacting more with their care teams, according to William Dahut, MD, chief scientific officer for the American Cancer Society. Many clinicians will advise their most immunocompromised patients the same as they did prior to the COVID-19 pandemic. 

“There’s always been guidelines that oncologists have given to patients who are immunocompromised – we always told them to avoid crowded places, crowded scenes, be outside more than inside,” Dr. Dahut said. “Those general recommendations will continue.”

The AAFP supports masking to limit COVID’s spread, but the “most important thing people can do is to get vaccinated,” Tochi Iroku-Malize, MD, MPH, MBA, president of the AAFP, said.

But the accessibility of vaccinations is also shifting.
 

Testing shifts

The government will continue to provide free COVID-19 vaccines because it still has supplies on hand. When this stock runs out, commercial insurance providers will be required to cover the immunizations, as they are considered preventive, but people without insurance will have to pay out of pocket. 

The AAFP is pushing the Biden administration and Congress to keep the purchase price of those vaccines low enough that clinicians can keep them in stock, according to Dr. Iroku-Malize. Once the federal government transitions COVID-19 vaccines to the commercial market – as early as later in 2023 – it may pose some challenges for providers. 

“If the price of the vaccines is too high, physician practices may struggle to make the upfront investment in COVID-19 vaccines,” Dr. Iroku-Malize said. “Patients often prefer to receive vaccine counseling and administration from their usual source of primary care, like their family physician.” 

The federal government has also said it still has a supply of treatments for the public to access for free, but has not revealed how much it has on hand or given a timeline for the transition to the private market. 

COVID-19 tests, meanwhile, are no longer covered because of the end of the public health emergency, and cost about $45 per kit on average, according to an analysis by the Kaiser Family Foundation.

Pediatrician Lisa Costello, MD, MPH, knows that price point will be a challenge for some families she cares for at West Virginia University Medicine Children’s Hospital in Morgantown. Many still ask her where they can access free tests. 

“Testing if you’re a higher risk person is something we need to ensure that people continue to be educated about,” Dr. Costello said. 

She’s hopeful that COVID-19 vaccines and treatments such as Paxlovid will stay free in the coming months so patients can continue to easily access them.
 

Future of telehealth

Relaxed regulations of prescribing controlled substances via telehealth and across state lines allowed clinicians to treat patients near and far during the pandemic. But many providers were worried about a proposal from the Drug Enforcement Administration to clamp down on the prescribing of controlled substances via telehealth, according to A. Mark Fendrick, MD, an internal medicine physician at the University of Michigan, Ann Arbor.

“We were all panicking about what was going to happen to what is for many clinicians a very valuable policy,” Dr. Fendrick said of the telehealth flexibilities introduced during COVID-19. 

The DEA, after getting 38,000 comments on their proposed regulations, pulled back on that plan, delaying the cliff until November. 

Dr. Fendrick said that telehealth has allowed clinicians to reach patients who have historically faced barriers to care, such as lacking transportation. 

“The benefits of that outweigh the potential harms,” he said. “Every policy you make that tightens access because you want to decrease the untoward and unfortunate outcomes will also decrease access to clinical indications.”

The AAFP said it hopes for clear guidance from the DEA in the coming months on what the new telehealth landscape for prescribing will look like.
 

Medicaid changes

About half of the patients who see Dr. Khanna have insurance through Medicaid. 

During the public health emergency, states were not allowed to remove anyone from Medicaid, regardless of whether they no longer qualified for the program or not. But a law passed by Congress last year requires states to once again check Medicaid eligibility. As many as 15 million people could lose their Medicaid coverage. 

That could affect the treatments Dr. Khanna recommends for her patients who get kicked off because those who become uninsured or transition to private insurance will have to pay more out of pocket. Maryland will start removals in June. 

“When you have an uninsured patient versus Medicaid, it’s a huge difference in what you can ask the patient to do – the medications you can provide, the testing you can provide,” Dr. Khanna said. 

States were authorized to remove people from Medicaid as of April 1, with Arkansas, New Hampshire, and South Dakota starting right away. But many states are just now getting the review process going. About a dozen states, including Indiana, Ohio, Utah, and West Virginia, started removing people in May 2023. 

Uninsurance rates hit record lows across the United States during the pandemic. Keeping Americans on health insurance is a top priority for the AAFP, Dr. Iroku-Malize said. “We know health care coverage disruptions prevent people from seeking and accessing the care they need.”

Many people who are removed from Medicaid will be eligible for health insurance through employers, or through the Affordable Care Act’s private marketplace. But premiums and deductibles are often higher in these plans, which studies have shown result in patients delaying medical visits and not filling prescriptions or receiving treatment.
 

Staying mindful

Hospitals that receive federal funds will still have to report COVID-19 test results to the Centers for Medicare & Medicaid Services through 2024, although private labs will no longer be obligated to do so. The Centers for Disease Control and Prevention will also continue to monitor virus levels in communities through wastewater. But some states will no longer collect data. 

Gone are the days when clinicians and others would watch for daily totals of case counts with the type of fervor typically reserved for live scoring updates during sports games, according to Dr. Costello.

“We just have to be mindful of the numbers that might be coming in,” Dr. Costello said.

Dr. Ransone, however, cautioned that clinicians not become complacent. In early May, Dr. Ransone saw two patients with conjunctivitis, what patients thought was simply pink eye – a symptom of the latest COVID-19 variant. Both patients told him it wasn’t possible they had COVID-19 because they didn’t have coughs. 

“I don’t want to see physician offices fall into that trap that it’s over and be a potential nidus for infection for other patients,” Dr. Ransone said. “It’s incumbent upon us to remind people of the current symptoms so that folks will know when they need to wear a mask when they’re around their grandmother.”

The move away from universal masking in the office has benefits. Many of his older patients have difficulty hearing and had used lip reading to help understand him, he said. During the pandemic, masks got in the way of that form of communication. Now they can see his mouth again and better decipher what he says.

“Being able to have that face-to-face contact, without a mask intervening, has been really beneficial for a lot of my older patients,” he said.

A version of this article first appeared on Medscape.com.

Depression rates among U.S. adults have reached the highest levels ever recorded since the national public opinion firm Gallup started tracking the mental illness in 2015.
 

In a survey, 29% of adults said they had been diagnosed with depression during their lifetime, and 18% said they currently have depression or are being treated for it. Those rates are up from the baseline 2015 rates of 20% of people ever having depression and 11% of people with a current diagnosis.

Depression had been steadily rising before the pandemic, and the Gallup analysts wrote that “social isolation, loneliness, fear of infection, psychological exhaustion (particularly among frontline responders such as health care workers), elevated substance abuse, and disruptions in mental health services have all likely played a role” in the increase.

“The fact that Americans are more depressed and struggling after this time of incredible stress and isolation is perhaps not surprising,” American Psychiatric Association president Rebecca Brendel, MD, told CNN. “There are lingering effects on our health, especially our mental health, from the past 3 years that disrupted everything we knew.”

The new estimates are based on online survey responses collected in February from 5,167 adults in the United States who answered the questions:

• Has a doctor or nurse ever told you that you have depression?
• Do you currently have or are you currently being treated for depression?

Depression, which is also called major depressive disorder, is a treatable illness that negatively affects how someone feels, thinks, and acts. The symptoms can be both emotional (such as sadness or loss of interest in activities) and physical (such as fatigue or slowed movements or speech).

The latest study found that depression rates increased the most among women, young adults, Black people, and Hispanic people. For the first time, more Black and Hispanic people than White people reported ever being diagnosed with depression. The lifetime depression rate among Black people was 34%, compared with 31% for Hispanic people and 29% for White people.

The rate of lifetime depression among women jumped 10 percentage points in the past 5 years, to 37%, in February, the survey results showed. About 1 in 4 women said they currently had depression or were being treated for it, up 6 percentage points compared with 5 years ago.

When responses were analyzed by age, those 18-44 years old were the most likely to report ever being diagnosed with depression or currently having the illness. About one-third of younger adults have ever been diagnosed, and more than 1 in 5 said they currently have depression.

Dr. Brendel said awareness and reduced stigma could be adding to the rising rates of depression.

“We’re making it easier to talk about mental health and looking at it as part of our overall wellness, just like physical health,” she said. “People are aware of depression, and people are seeking help for it.”

If you or someone you know needs help, dial 988 for support from the national Suicide & Crisis Lifeline. It’s free, confidential, and available 24 hours a day, 7 days a week. You can also visit 988lifeline.org and choose the chat feature.

A version of this article first appeared on Medscape.com.

Depression rates among U.S. adults have reached the highest levels ever recorded since the national public opinion firm Gallup started tracking the mental illness in 2015.
 

In a survey, 29% of adults said they had been diagnosed with depression during their lifetime, and 18% said they currently have depression or are being treated for it. Those rates are up from the baseline 2015 rates of 20% of people ever having depression and 11% of people with a current diagnosis.

Depression had been steadily rising before the pandemic, and the Gallup analysts wrote that “social isolation, loneliness, fear of infection, psychological exhaustion (particularly among frontline responders such as health care workers), elevated substance abuse, and disruptions in mental health services have all likely played a role” in the increase.

“The fact that Americans are more depressed and struggling after this time of incredible stress and isolation is perhaps not surprising,” American Psychiatric Association president Rebecca Brendel, MD, told CNN. “There are lingering effects on our health, especially our mental health, from the past 3 years that disrupted everything we knew.”

The new estimates are based on online survey responses collected in February from 5,167 adults in the United States who answered the questions:

• Has a doctor or nurse ever told you that you have depression?
• Do you currently have or are you currently being treated for depression?

Depression, which is also called major depressive disorder, is a treatable illness that negatively affects how someone feels, thinks, and acts. The symptoms can be both emotional (such as sadness or loss of interest in activities) and physical (such as fatigue or slowed movements or speech).

The latest study found that depression rates increased the most among women, young adults, Black people, and Hispanic people. For the first time, more Black and Hispanic people than White people reported ever being diagnosed with depression. The lifetime depression rate among Black people was 34%, compared with 31% for Hispanic people and 29% for White people.

The rate of lifetime depression among women jumped 10 percentage points in the past 5 years, to 37%, in February, the survey results showed. About 1 in 4 women said they currently had depression or were being treated for it, up 6 percentage points compared with 5 years ago.

When responses were analyzed by age, those 18-44 years old were the most likely to report ever being diagnosed with depression or currently having the illness. About one-third of younger adults have ever been diagnosed, and more than 1 in 5 said they currently have depression.

Dr. Brendel said awareness and reduced stigma could be adding to the rising rates of depression.

“We’re making it easier to talk about mental health and looking at it as part of our overall wellness, just like physical health,” she said. “People are aware of depression, and people are seeking help for it.”

If you or someone you know needs help, dial 988 for support from the national Suicide & Crisis Lifeline. It’s free, confidential, and available 24 hours a day, 7 days a week. You can also visit 988lifeline.org and choose the chat feature.

A version of this article first appeared on Medscape.com.

Depression rates among U.S. adults have reached the highest levels ever recorded since the national public opinion firm Gallup started tracking the mental illness in 2015.
 

In a survey, 29% of adults said they had been diagnosed with depression during their lifetime, and 18% said they currently have depression or are being treated for it. Those rates are up from the baseline 2015 rates of 20% of people ever having depression and 11% of people with a current diagnosis.

Depression had been steadily rising before the pandemic, and the Gallup analysts wrote that “social isolation, loneliness, fear of infection, psychological exhaustion (particularly among frontline responders such as health care workers), elevated substance abuse, and disruptions in mental health services have all likely played a role” in the increase.

“The fact that Americans are more depressed and struggling after this time of incredible stress and isolation is perhaps not surprising,” American Psychiatric Association president Rebecca Brendel, MD, told CNN. “There are lingering effects on our health, especially our mental health, from the past 3 years that disrupted everything we knew.”

The new estimates are based on online survey responses collected in February from 5,167 adults in the United States who answered the questions:

• Has a doctor or nurse ever told you that you have depression?
• Do you currently have or are you currently being treated for depression?

Depression, which is also called major depressive disorder, is a treatable illness that negatively affects how someone feels, thinks, and acts. The symptoms can be both emotional (such as sadness or loss of interest in activities) and physical (such as fatigue or slowed movements or speech).

The latest study found that depression rates increased the most among women, young adults, Black people, and Hispanic people. For the first time, more Black and Hispanic people than White people reported ever being diagnosed with depression. The lifetime depression rate among Black people was 34%, compared with 31% for Hispanic people and 29% for White people.

The rate of lifetime depression among women jumped 10 percentage points in the past 5 years, to 37%, in February, the survey results showed. About 1 in 4 women said they currently had depression or were being treated for it, up 6 percentage points compared with 5 years ago.

When responses were analyzed by age, those 18-44 years old were the most likely to report ever being diagnosed with depression or currently having the illness. About one-third of younger adults have ever been diagnosed, and more than 1 in 5 said they currently have depression.

Dr. Brendel said awareness and reduced stigma could be adding to the rising rates of depression.

“We’re making it easier to talk about mental health and looking at it as part of our overall wellness, just like physical health,” she said. “People are aware of depression, and people are seeking help for it.”

If you or someone you know needs help, dial 988 for support from the national Suicide & Crisis Lifeline. It’s free, confidential, and available 24 hours a day, 7 days a week. You can also visit 988lifeline.org and choose the chat feature.

A version of this article first appeared on Medscape.com.

Key clinical point: Adjuvant supplementation with single-strain probiotic lactobacilli significantly reduced the SCORing Atopic Dermatitis (SCORAD) index in young patients with atopic dermatitis (AD).

Major finding: The single-strain probiotic lactobacilli vs placebo group had a significant reduction in the SCORAD index (mean difference −4.50; P  =  .003).

Study details: Findings are from a meta-analysis of 14 studies involving 1124 patients aged 0-18 years with AD who received single-strain probiotic lactobacilli (n = 574) or placebo (n = 550).

Disclosures: This study was funded by the Slovenian Research Agency. The authors declared no conflicts of interest.

Source: Fijan S et al. Single-strain probiotic lactobacilli for the treatment of atopic dermatitis in children: A systematic review and meta-analysis. Pharmaceutics. 2023;15(4):1256 (Apr 17). Doi: 10.3390/pharmaceutics15041256

Key clinical point: Adjuvant supplementation with single-strain probiotic lactobacilli significantly reduced the SCORing Atopic Dermatitis (SCORAD) index in young patients with atopic dermatitis (AD).

Major finding: The single-strain probiotic lactobacilli vs placebo group had a significant reduction in the SCORAD index (mean difference −4.50; P  =  .003).

Study details: Findings are from a meta-analysis of 14 studies involving 1124 patients aged 0-18 years with AD who received single-strain probiotic lactobacilli (n = 574) or placebo (n = 550).

Disclosures: This study was funded by the Slovenian Research Agency. The authors declared no conflicts of interest.

Source: Fijan S et al. Single-strain probiotic lactobacilli for the treatment of atopic dermatitis in children: A systematic review and meta-analysis. Pharmaceutics. 2023;15(4):1256 (Apr 17). Doi: 10.3390/pharmaceutics15041256

Key clinical point: Adjuvant supplementation with single-strain probiotic lactobacilli significantly reduced the SCORing Atopic Dermatitis (SCORAD) index in young patients with atopic dermatitis (AD).

Major finding: The single-strain probiotic lactobacilli vs placebo group had a significant reduction in the SCORAD index (mean difference −4.50; P  =  .003).

Study details: Findings are from a meta-analysis of 14 studies involving 1124 patients aged 0-18 years with AD who received single-strain probiotic lactobacilli (n = 574) or placebo (n = 550).

Disclosures: This study was funded by the Slovenian Research Agency. The authors declared no conflicts of interest.

Source: Fijan S et al. Single-strain probiotic lactobacilli for the treatment of atopic dermatitis in children: A systematic review and meta-analysis. Pharmaceutics. 2023;15(4):1256 (Apr 17). Doi: 10.3390/pharmaceutics15041256

Key clinical point: A lower alpha diversity in infancy is associated with an increased risk for atopic dermatitis (AD) in children of parents with atopy.

Major finding: Overall, the skin microbiome at birth and 2 months of age was not associated with the subsequent development of AD (P  =  .2). However, a lower alpha diversity at 2 months of age was significantly associated with an increased risk for AD during the first 2 years in children with at least 1 parent (adjusted hazard ratio [aHR] 1.67; P  =  .03) or both parents (aHR 4.44; P  =  .04) with a history of atopy.

Study details: Findings are from a prospective analysis of 300 children born to term, of which 153 had a parental history of atopy.

Disclosures: This study was funded by The Leo Foundation and others. Some authors declared serving as speakers, advisors, or consultants for or receiving research grants or speaker or consulting honoraria from various organizations, including the study funders.

Source: Halling AS et al. Reduced skin microbiome diversity in infancy is associated with increased risk of atopic dermatitis in high-risk children. J Invest Dermatol. 2023 (Apr 19). Doi: 10.1016/j.jid.2023.03.1682

Key clinical point: A lower alpha diversity in infancy is associated with an increased risk for atopic dermatitis (AD) in children of parents with atopy.

Major finding: Overall, the skin microbiome at birth and 2 months of age was not associated with the subsequent development of AD (P  =  .2). However, a lower alpha diversity at 2 months of age was significantly associated with an increased risk for AD during the first 2 years in children with at least 1 parent (adjusted hazard ratio [aHR] 1.67; P  =  .03) or both parents (aHR 4.44; P  =  .04) with a history of atopy.

Study details: Findings are from a prospective analysis of 300 children born to term, of which 153 had a parental history of atopy.

Disclosures: This study was funded by The Leo Foundation and others. Some authors declared serving as speakers, advisors, or consultants for or receiving research grants or speaker or consulting honoraria from various organizations, including the study funders.

Source: Halling AS et al. Reduced skin microbiome diversity in infancy is associated with increased risk of atopic dermatitis in high-risk children. J Invest Dermatol. 2023 (Apr 19). Doi: 10.1016/j.jid.2023.03.1682

Key clinical point: A lower alpha diversity in infancy is associated with an increased risk for atopic dermatitis (AD) in children of parents with atopy.

Major finding: Overall, the skin microbiome at birth and 2 months of age was not associated with the subsequent development of AD (P  =  .2). However, a lower alpha diversity at 2 months of age was significantly associated with an increased risk for AD during the first 2 years in children with at least 1 parent (adjusted hazard ratio [aHR] 1.67; P  =  .03) or both parents (aHR 4.44; P  =  .04) with a history of atopy.

Study details: Findings are from a prospective analysis of 300 children born to term, of which 153 had a parental history of atopy.

Disclosures: This study was funded by The Leo Foundation and others. Some authors declared serving as speakers, advisors, or consultants for or receiving research grants or speaker or consulting honoraria from various organizations, including the study funders.

Source: Halling AS et al. Reduced skin microbiome diversity in infancy is associated with increased risk of atopic dermatitis in high-risk children. J Invest Dermatol. 2023 (Apr 19). Doi: 10.1016/j.jid.2023.03.1682

Key clinical point: Patients with atopic dermatitis (AD) have a 1.28-fold increased risk of developing rheumatoid arthritis (RA) but patients with RA do not have an increased risk of developing AD.

Major finding: Patients with AD had a significantly increased risk of developing RA (odds ratio [OR] 1.28; P < .001). However, the risk of developing AD in patients with RA was not significant (OR 1.10; P  =  .52).

Study details: The data come from a systematic review and meta-analysis of nine studies that investigated the association between AD and RA.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Williams RC et al. The uni-directional association of atopic dermatitis and rheumatoid arthritis: A systematic review and meta‑analysis. Arch Dermatol Res. 2023 (Apr 12). Doi: 10.1007/s00403-023-02619-0

Key clinical point: Patients with atopic dermatitis (AD) have a 1.28-fold increased risk of developing rheumatoid arthritis (RA) but patients with RA do not have an increased risk of developing AD.

Major finding: Patients with AD had a significantly increased risk of developing RA (odds ratio [OR] 1.28; P < .001). However, the risk of developing AD in patients with RA was not significant (OR 1.10; P  =  .52).

Study details: The data come from a systematic review and meta-analysis of nine studies that investigated the association between AD and RA.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Williams RC et al. The uni-directional association of atopic dermatitis and rheumatoid arthritis: A systematic review and meta‑analysis. Arch Dermatol Res. 2023 (Apr 12). Doi: 10.1007/s00403-023-02619-0

Key clinical point: Patients with atopic dermatitis (AD) have a 1.28-fold increased risk of developing rheumatoid arthritis (RA) but patients with RA do not have an increased risk of developing AD.

Major finding: Patients with AD had a significantly increased risk of developing RA (odds ratio [OR] 1.28; P < .001). However, the risk of developing AD in patients with RA was not significant (OR 1.10; P  =  .52).

Study details: The data come from a systematic review and meta-analysis of nine studies that investigated the association between AD and RA.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Williams RC et al. The uni-directional association of atopic dermatitis and rheumatoid arthritis: A systematic review and meta‑analysis. Arch Dermatol Res. 2023 (Apr 12). Doi: 10.1007/s00403-023-02619-0

Key clinical point: Treatment with an emollient plus balm significantly reduced corticosteroid use compared with routine treatment with commercial emollients in patients with mild-to-moderate atopic dermatitis (AD).

Major finding: Until day 28, patients receiving emollient plus balm vs a commercial classical emollient used a significantly lower mean amount of corticosteroid (6.03 vs 9.16 g; P  =  .041), with corticosteroids being used on fewer days (37.5% vs 46.9% of days; P  =  .0256) and fewer times daily (0.55 vs 0.71 applications/day; P  =  .0203).

Study details: This single-center randomized controlled study included 119 patients age ≥3 years with mild-to-moderate AD who were randomly assigned to receive an emollient plus balm combination (n = 58) or a classical emollient (n = 61) for 28 days, both along with topical corticosteroids when necessary and as per prescription.

Disclosures: This study was supported by La Roche-Posay (LRP). A-L Demessant-Flavigny, S Salah, and D Kerob declared being employees of LRP. H Zelenkova reported no conflicts of interest.

Source: Zelenkova H et al. Impact of daily use of emollient ‘plus’ on corticosteroid consumption in patients with atopic dermatitis: An open, randomized controlled study. J Eur Acad Dermatol Venereol. 2023 (Apr 24). Doi: 10.1111/jdv.18947

Key clinical point: Treatment with an emollient plus balm significantly reduced corticosteroid use compared with routine treatment with commercial emollients in patients with mild-to-moderate atopic dermatitis (AD).

Major finding: Until day 28, patients receiving emollient plus balm vs a commercial classical emollient used a significantly lower mean amount of corticosteroid (6.03 vs 9.16 g; P  =  .041), with corticosteroids being used on fewer days (37.5% vs 46.9% of days; P  =  .0256) and fewer times daily (0.55 vs 0.71 applications/day; P  =  .0203).

Study details: This single-center randomized controlled study included 119 patients age ≥3 years with mild-to-moderate AD who were randomly assigned to receive an emollient plus balm combination (n = 58) or a classical emollient (n = 61) for 28 days, both along with topical corticosteroids when necessary and as per prescription.

Disclosures: This study was supported by La Roche-Posay (LRP). A-L Demessant-Flavigny, S Salah, and D Kerob declared being employees of LRP. H Zelenkova reported no conflicts of interest.

Source: Zelenkova H et al. Impact of daily use of emollient ‘plus’ on corticosteroid consumption in patients with atopic dermatitis: An open, randomized controlled study. J Eur Acad Dermatol Venereol. 2023 (Apr 24). Doi: 10.1111/jdv.18947

Key clinical point: Treatment with an emollient plus balm significantly reduced corticosteroid use compared with routine treatment with commercial emollients in patients with mild-to-moderate atopic dermatitis (AD).

Major finding: Until day 28, patients receiving emollient plus balm vs a commercial classical emollient used a significantly lower mean amount of corticosteroid (6.03 vs 9.16 g; P  =  .041), with corticosteroids being used on fewer days (37.5% vs 46.9% of days; P  =  .0256) and fewer times daily (0.55 vs 0.71 applications/day; P  =  .0203).

Study details: This single-center randomized controlled study included 119 patients age ≥3 years with mild-to-moderate AD who were randomly assigned to receive an emollient plus balm combination (n = 58) or a classical emollient (n = 61) for 28 days, both along with topical corticosteroids when necessary and as per prescription.

Disclosures: This study was supported by La Roche-Posay (LRP). A-L Demessant-Flavigny, S Salah, and D Kerob declared being employees of LRP. H Zelenkova reported no conflicts of interest.

Source: Zelenkova H et al. Impact of daily use of emollient ‘plus’ on corticosteroid consumption in patients with atopic dermatitis: An open, randomized controlled study. J Eur Acad Dermatol Venereol. 2023 (Apr 24). Doi: 10.1111/jdv.18947

Key clinical point: Tralokinumab demonstrated promising efficacy and an acceptable safety profile in a real-world cohort of patients with a long history of moderate-to-severe atopic dermatitis (AD) and multiple treatment failures.

Major finding: At week 16, the mean Eczema Area and Severity Index (EASI), SCORing AD, and peak pruritus numerical rating scale scores improved by 70.4%, 64.1%, and 57.1%, respectively (all P < .0001), and 57.6% of patients achieved a ≥75% improvement in EASI scores. The safety profile was acceptable.

Study details: Findings are from a multicenter retrospective study including 85 adult patients with moderate-to-severe AD who had unsuccessfully used prior therapy with systemics, biologics, or a Janus kinase inhibitor (n = 27) or were naive to advanced therapy (n = 58) and received tralokinumab.

Disclosures: This study did not receive any funding. Some authors declared serving as investigators, speakers, or consultants for or receiving lecture, speaking, or consulting fees from various sources.

Source: Pereyra-Rodriguez JJ et al. Treatment of severe atopic dermatitis with tralokinumab in real clinical practice. Short-term effectiveness and safety results. Clin Exp Dermatol. 2023 (Apr 25). Doi: 10.1093/ced/llad153

Key clinical point: Tralokinumab demonstrated promising efficacy and an acceptable safety profile in a real-world cohort of patients with a long history of moderate-to-severe atopic dermatitis (AD) and multiple treatment failures.

Major finding: At week 16, the mean Eczema Area and Severity Index (EASI), SCORing AD, and peak pruritus numerical rating scale scores improved by 70.4%, 64.1%, and 57.1%, respectively (all P < .0001), and 57.6% of patients achieved a ≥75% improvement in EASI scores. The safety profile was acceptable.

Study details: Findings are from a multicenter retrospective study including 85 adult patients with moderate-to-severe AD who had unsuccessfully used prior therapy with systemics, biologics, or a Janus kinase inhibitor (n = 27) or were naive to advanced therapy (n = 58) and received tralokinumab.

Disclosures: This study did not receive any funding. Some authors declared serving as investigators, speakers, or consultants for or receiving lecture, speaking, or consulting fees from various sources.

Source: Pereyra-Rodriguez JJ et al. Treatment of severe atopic dermatitis with tralokinumab in real clinical practice. Short-term effectiveness and safety results. Clin Exp Dermatol. 2023 (Apr 25). Doi: 10.1093/ced/llad153

Key clinical point: Tralokinumab demonstrated promising efficacy and an acceptable safety profile in a real-world cohort of patients with a long history of moderate-to-severe atopic dermatitis (AD) and multiple treatment failures.

Major finding: At week 16, the mean Eczema Area and Severity Index (EASI), SCORing AD, and peak pruritus numerical rating scale scores improved by 70.4%, 64.1%, and 57.1%, respectively (all P < .0001), and 57.6% of patients achieved a ≥75% improvement in EASI scores. The safety profile was acceptable.

Study details: Findings are from a multicenter retrospective study including 85 adult patients with moderate-to-severe AD who had unsuccessfully used prior therapy with systemics, biologics, or a Janus kinase inhibitor (n = 27) or were naive to advanced therapy (n = 58) and received tralokinumab.

Disclosures: This study did not receive any funding. Some authors declared serving as investigators, speakers, or consultants for or receiving lecture, speaking, or consulting fees from various sources.

Source: Pereyra-Rodriguez JJ et al. Treatment of severe atopic dermatitis with tralokinumab in real clinical practice. Short-term effectiveness and safety results. Clin Exp Dermatol. 2023 (Apr 25). Doi: 10.1093/ced/llad153

Key clinical point: Compared with the usual emollient and cleanser skincare routine, an emollient plus balm combination significantly improved pruritus in patients with moderate-to-severe atopic dermatitis (AD) receiving systemic treatment.

Major finding: Patients treated with an emollient plus balm combination after pre-cleaning with a syndet (emollient “plus” group) vs the usual emollient and cleanser skincare routine (control group) had a significantly greater mean decrease in current pruritus after 70 days (P  =  .0277) and worse pruritus over the last 24 hours after 42 days (P  =  .025) of treatment.

Study details: This randomized controlled multicenter study included 57 adult patients with moderate-to-severe AD using systemic treatment who were randomly assigned 1:1 to the emollient “plus” group or the control group.

Disclosures: This study was funded by La Roche-Posay (LRP). Two authors declared being employees of LRP, and some authors declared serving on advisory boards or as speakers, consultants, or investigators in the presented trial or other clinical trials sponsored by various sources, including LRP.

Source: Magnolo N et al. Comparison of different skin care regimens in patients with moderate to severe atopic dermatitis receiving systemic treatment: A randomized controlled trial. J Eur Acad Dermatol Venereol. 2023 (Apr 24). Doi: 10.1111/jdv.18949

Key clinical point: Compared with the usual emollient and cleanser skincare routine, an emollient plus balm combination significantly improved pruritus in patients with moderate-to-severe atopic dermatitis (AD) receiving systemic treatment.

Major finding: Patients treated with an emollient plus balm combination after pre-cleaning with a syndet (emollient “plus” group) vs the usual emollient and cleanser skincare routine (control group) had a significantly greater mean decrease in current pruritus after 70 days (P  =  .0277) and worse pruritus over the last 24 hours after 42 days (P  =  .025) of treatment.

Study details: This randomized controlled multicenter study included 57 adult patients with moderate-to-severe AD using systemic treatment who were randomly assigned 1:1 to the emollient “plus” group or the control group.

Disclosures: This study was funded by La Roche-Posay (LRP). Two authors declared being employees of LRP, and some authors declared serving on advisory boards or as speakers, consultants, or investigators in the presented trial or other clinical trials sponsored by various sources, including LRP.

Source: Magnolo N et al. Comparison of different skin care regimens in patients with moderate to severe atopic dermatitis receiving systemic treatment: A randomized controlled trial. J Eur Acad Dermatol Venereol. 2023 (Apr 24). Doi: 10.1111/jdv.18949

Key clinical point: Compared with the usual emollient and cleanser skincare routine, an emollient plus balm combination significantly improved pruritus in patients with moderate-to-severe atopic dermatitis (AD) receiving systemic treatment.

Major finding: Patients treated with an emollient plus balm combination after pre-cleaning with a syndet (emollient “plus” group) vs the usual emollient and cleanser skincare routine (control group) had a significantly greater mean decrease in current pruritus after 70 days (P  =  .0277) and worse pruritus over the last 24 hours after 42 days (P  =  .025) of treatment.

Study details: This randomized controlled multicenter study included 57 adult patients with moderate-to-severe AD using systemic treatment who were randomly assigned 1:1 to the emollient “plus” group or the control group.

Disclosures: This study was funded by La Roche-Posay (LRP). Two authors declared being employees of LRP, and some authors declared serving on advisory boards or as speakers, consultants, or investigators in the presented trial or other clinical trials sponsored by various sources, including LRP.

Source: Magnolo N et al. Comparison of different skin care regimens in patients with moderate to severe atopic dermatitis receiving systemic treatment: A randomized controlled trial. J Eur Acad Dermatol Venereol. 2023 (Apr 24). Doi: 10.1111/jdv.18949

Key clinical point: Dupilumab is efficacious and safe in pediatric patients with uncontrolled atopic dermatitis (AD), including those aged 2 to <6 years.

Major finding: At week 16, the mean Eczema Area and Severity Index (EASI) score decreased significantly from 29.0 to 5.1 (P < .0001) and 73.3% and 53.3% of patients achieved ≥75% improvement in EASI and Scoring Atopic Dermatitis scores, respectively. The change in clinical scores was similar among the 2 to <6-year, 6 to <12-year, and 12 to <18-year subgroups. No serious treatment-emergent adverse events were observed.

Study details: This single-center real-world retrospective study included 39 patients aged 2 to <18 years with uncontrolled AD who received dupilumab therapy.

Disclosures: This study was supported by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Wang Y et al. Dupilumab improves clinical scores in pediatric patients aged 2 to <18 years with uncontrolled atopic dermatitis: A single-center, real-world study. Dermatol Ther. 2023;5626410 (Apr 17). Doi: 10.1155/2023/5626410

Key clinical point: Dupilumab is efficacious and safe in pediatric patients with uncontrolled atopic dermatitis (AD), including those aged 2 to <6 years.

Major finding: At week 16, the mean Eczema Area and Severity Index (EASI) score decreased significantly from 29.0 to 5.1 (P < .0001) and 73.3% and 53.3% of patients achieved ≥75% improvement in EASI and Scoring Atopic Dermatitis scores, respectively. The change in clinical scores was similar among the 2 to <6-year, 6 to <12-year, and 12 to <18-year subgroups. No serious treatment-emergent adverse events were observed.

Study details: This single-center real-world retrospective study included 39 patients aged 2 to <18 years with uncontrolled AD who received dupilumab therapy.

Disclosures: This study was supported by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Wang Y et al. Dupilumab improves clinical scores in pediatric patients aged 2 to <18 years with uncontrolled atopic dermatitis: A single-center, real-world study. Dermatol Ther. 2023;5626410 (Apr 17). Doi: 10.1155/2023/5626410

Key clinical point: Dupilumab is efficacious and safe in pediatric patients with uncontrolled atopic dermatitis (AD), including those aged 2 to <6 years.

Major finding: At week 16, the mean Eczema Area and Severity Index (EASI) score decreased significantly from 29.0 to 5.1 (P < .0001) and 73.3% and 53.3% of patients achieved ≥75% improvement in EASI and Scoring Atopic Dermatitis scores, respectively. The change in clinical scores was similar among the 2 to <6-year, 6 to <12-year, and 12 to <18-year subgroups. No serious treatment-emergent adverse events were observed.

Study details: This single-center real-world retrospective study included 39 patients aged 2 to <18 years with uncontrolled AD who received dupilumab therapy.

Disclosures: This study was supported by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Wang Y et al. Dupilumab improves clinical scores in pediatric patients aged 2 to <18 years with uncontrolled atopic dermatitis: A single-center, real-world study. Dermatol Ther. 2023;5626410 (Apr 17). Doi: 10.1155/2023/5626410