Atopic dermatitis is a chronic disease with skin lesions accompanied by itching that greatly affects the quality of life as well as work and study efficiency, and can even affect the development of children.
Atopic dermatitis affects approximately 5 to over 20 percent of children and adult worldwide, with large variations among ethnic groups and countries. Vietnam and countries in the Asia-Pacific region, Africa, and Oceania have higher rates of atopic dermatitis than countries in the Northern/Eastern Europe and Indian subcontinent.
In Vietnam, atopic dermatitis can be managed in many different hospitals or specialties such as dermatology, allergy and immunology, and pediatrics. However, there is no center for managing atopic dermatitis comprehensively coordinating many specialties. Additionally, patient examination time in Vietnam is often very short, leading to incomplete time for thorough explanations for patients, thereby affecting compliance and leading to poor treatment effectiveness. Consequently, there will be multiple flares with poor control and the patient will likely seek care at multiple hospitals leading to lack of continuity of care.
The ADCARE programme is an initiative by GA2LEN (Global Allergy and Asthma Excellence Network) for increasing the knowledge of atopic dermatitis by research, advocating for awareness, and accrediting an interactive network of centers of reference and excellence worldwide.
In that context, Vinmec Times City International Hospital has presided over the development of atopic dermatitis management program according to ADCARE's 32 strict criteria. With this goal, Vinmec Times City has become the first center of excellence for Atopic Dermatitis - ADCARE in Vietnam. From that, we have:
- Developed an examination process with a team of experts and updated treatment regimens according to international standards.
- Developed and provided patients with comprehensive and easy-to-understand health education materials and programs to raise awareness about atopic dermatitis.
- Improved the quality of management and treatment outcomes assessed through Patient-Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs).
- Participated in researches on atopic dermatitis to increase understanding of atopic dermatitis in Vietnam and the world.
Action roadmap and results
Phase 1: Program development (6/2022-8/2022)
We established a multidisciplinary team for atopic dermatitis management with our core center, including allergist/immunologists, pediatric allergists/immunologists, and dermatologists.
We formulated specialty documents in adherence to ADCARE's criteria and updated international guidelines, including atopic dermatitis clinical pathways, training materials, and assessment checklists.
All patients were diagnosed and graded for severity based on the SCORAD scale. Initial treatment was selected based on the severity of the disease and the location of skin lesions. Most importantly, these patients were assessed for treatment response after 2 weeks and further treatment was also determined.
The handbook contains patient-friendly content regarding atopic dermatitis, including causes (ex. food, environmental allergies), effects on life, treatment and management (including skin care), management of atopic dermatitis at Vinmec Times City, self-assessment of dermatitis at home, and when to be seen by a doctor.
Phase 2: Implementation and assessment (9/2022 – 8/2023)
Training for physicians and nurses
We hosted on-site training with allergy and clinical immunology experts from the US and Australia for physicians and nurses, aimed at standardizing their knowledge and practical skills in accordance with our specialized clinical pathway for the management of atopic dermatitis and implementation of our clinical pathway compliance assessment.
Counselling of patients and their families
We recognized that counselling of patients and their families, for example on skin care, triggers of exacerbation, stress, and daily life issues can help to optimize atopic dermatitis management with direct health education during examination and through books for health education. For this reason, we also organized atopic dermatitis patient club meetings every 6 months to improve understanding of atopic dermatitis for patients.
Quality of management and treatment outcomes
Patient-Reported Outcome Measures (PROMs) results with POEM score
We utilized the POEM scale for the patients to self-assess and monitor the severity of their dermatitis. POEM scores were assessed at the first visit and after 2 weeks at the follow-up visit or by phone interview. Results of monitoring POEM scores showed a clear improvement in the severity of atopic dermatitis after 2 weeks of treatment, with an average decrease in POEM scores from 6 to 8 points (Figure 2). The POEM reduction of 6 points or more was significant in assessing clinical effectiveness.
We have been interviewing for the patients' satisfaction levels when visiting our center since the fourth quarter of 2022. Within one year, 133 patients were interviewed, the number of patients in the Q4 2022, Q1/2023, Q2 2023 and Q3/2023 were 32, 27, 44 and 30 respectively.
Based on the implementation of the standardized procedures and promotion of patient health education, we have observed continuous improvement in term of the atopic dermatitis treatment outcomes and patient satisfaction at our center.
Scientific activity
In 2022, we published a case report with DOCK8 deficiency in patients with severe atopic dermatitis and we wrote a book chapter on atopic dermatitis in the book, Allergic Immunity Approached from Cases in Clinics, published by Vietnamese Medicine Publishing House.
In 2023, we continued to conduct research and clinical trials on atopic dermatitis. In October 2023, we reported the results of research on sensitization to common allergens in children with atopic dermatitis at the Vietnam Open Pediatric Allergic Immunology conference in Ho Chi Minh City.
We have been interviewing for the patients' satisfaction levels when visiting our center since the fourth quarter of 2022. Within one year, 133 patients were interviewed, the number of patients in the Q4 2022, Q1/2023, Q2 2023 and Q3/2023 were 32, 27, 44 and 30 respectively.
Based on the implementation of the standardized procedures and promotion of patient health education, we have observed continuous improvement in term of the atopic dermatitis treatment outcomes and patient satisfaction at our center.
Scientific activity
In 2022, we published a case report with DOCK8 deficiency in patients with severe atopic dermatitis and we wrote a book chapter on atopic dermatitis in the book, Allergic Immunity Approached from Cases in Clinics, published by Vietnamese Medicine Publishing House.
In 2023, we continued to conduct research and clinical trials on atopic dermatitis. In October 2023, we reported the results of research on sensitization to common allergens in children with atopic dermatitis at the Vietnam Open Pediatric Allergic Immunology conference in Ho Chi Minh City.
Auditing and certification
We worked with ADCARE's audit team on August 17, 2023 directly at Vinmec Times City. After reviewing ADCARE's 32 rigorous criteria for a GALEN Atopic Dermatitis Center of Excellence and Reference and the vote of a panel of experts, we achieved ADCARE certification and became the first Center of Excellence for Atopic Dermatitis in Vietnam.
Phase 3: Accreditation and continued sustainability (8/2023 – present)
After achieving ADCARE's atopic dermatitis center of excellence certification, we continued to maintain quality control, training and research activities to prepare for the re-accreditation in July 2025. We also had the opportunity to participate in research activities and received professional exchanges with ADCARE experts.
Conclusions
Vinmec Times City is the first organization in Vietnam recognized as a Center of Excellence for atopic dermatitis management and treatment with all 32 strict criteria of ADCARE.
Practicing according to ADCARE criteria helps:
- Standardize diagnostic and treatment procedures.
- Strengthen staff training and self-education as well as health education for patients and family members.
- Improve treatment outcomes and patient experience.
- Promote scientific research and scientific activities.
We believe that, given these promising results, other hospitals in Vietnam can learn from and apply ADCARE standards to enhance the quality of care and treatment, particularly for atopic dermatitis patients, and more broadly, for asthma and allergic patients.
