Home phototherapy: Improving access to dermatologic care

ABSTRACT

Introduction: Phototherapy is an effective, economic dermatologic treatment with few side effects. Home phototherapy has the potential to overcome barriers that patients face in accessing care (e.g., frequent clinic visits, travel, co-pays, etc.). This study evaluated the feasibility and acceptability of a home phototherapy program at the University of Rochester. Methods: A retrospective review of electronic medical records and a telephone survey were conducted of all adult patients (≥18 years) prescribed home phototherapy for a dermatologic condition (2019-2021). Data collected from chart review included demographics and disease course. Telephone surveys consisted of 12 questions regarding device use, Perceived Global Impression of Severity (PGIS), Skindex-mini, satisfaction with care, and treatment preference. Institutional review board approval was obtained. Results: Of 63 eligible subjects, 43 (68%) participated in the survey (n = 23 psoriasis, n = 11 atopic dermatitis, n = 9 with other diseases). The average disease severity on PGIS at the time of survey was 2.72 (mild). Most subjects surveyed (88.4%) felt their disease had improved since initiating home phototherapy. All subjects preferred home therapy to in-office phototherapy due to the convenience (74.4%), distance they lived from clinic (27.9%), reduced cost (23.3%), work and household obligations (20.9%), privacy (14.0%), and COVID-19 related concerns (14.0%). Notably, 18.6% experienced side effects, most commonly erythema. Discussion: Home phototherapy is safe and effective, particularly for patients who have difficulty obtaining in-office care. It also presents a promising alternative to in-person care during the COVID-19 pandemic. Insurance carriers can save significant funds by instituting such programs and avoiding more costly systemic therapies.