Why physicians underuse patient-reported outcomes in atopic dermatitis and chronic urticaria — Insights from the UCARE/ADCARE PROMUSE study

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Background: LEN UCARE (Urticaria Centers of Reference and Excellence) and ADCARE (Angioedema Centers of Reference and Excellence) networks found that patient-reported outcome measures (PROMs) are underused in clinical practice for atopic dermatitis (AD) and chronic urticaria (CU). The reasons for this remain unknown. We studied why physicians have reservations about using PROMs, how PROM use is affected by the barriers they perceive, and what the physician demographics/characteristics associated with these barriers are. Methods: This is an observational, cross-sectional study where the PROMUSE questionnaire was used and applied to physicians from 45 specialized centers worldwide. Of the 2534 physicians surveyed in the PROMUSE study, 474 who treated patients with AD and CU were included in the analysis. Results: For the 474 physicians who treat AD and CU patients, the most common issues perceived as primary barriers to PROM use were "time constraints" (n = 455/474), "not mandated to complete" (n = 428/474), and "patients dislike PROMs" (n = 425/474). Higher rates of barrier perception were observed for males, younger physicians, and non-specialist physicians. The more barriers physicians perceive, the less frequently PROMs are used, with a strong and significant negative correlation between the number of barriers perceived and the frequency of PROM use. Two of the 15 perceived barriers significantly prevented using PROMs: the belief that PROMs constrain the doctor-patient relationship and the belief that patients dislike them. Conclusions: The underutilization of PROMs in AD and CU is strongly driven by physicians' perceptions that patients dislike them and that they constrain the doctor-patient relationship. This suggests physicians may have deeper insights into the practical shortcomings of current instruments. Therefore, rather than solely focusing on physician education, existing AD and CU PROMs urgently require re-evaluation and co-development with direct patient involvement (eg, Core Outcome Sets) to ensure they are genuinely patient-centered and clinically relevant.

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