Understanding Clinical Inertia in Atopic Dermatitis: A Mixed-Methods Study of Barriers to Treatment Escalation

This study highlights a multifactorial pattern of clinical inertia in AD, with patient perception, therapeutic communication, and healthcare structures all playing a role. These findings underscore the need for structured shared decision-making (e.g., standardized risk-benefit counseling and written decision aids about systemic options), treat-to-target management (regular POEM/DLQI monitoring with predefined escalation triggers when targets are not met), and system-level improvements (clear referral pathways to AD specialists, adequate follow-up capacity, and streamlined approval processes for systemic therapies) to reduce delays in escalation and improve outcomes. As AD treatment options expand, addressing clinical inertia is critical to ensure timely and equitable care.