Clinicians’ perspectives of shared care of psoriatic arthritis and psoriasis between rheumatology and dermatology: an interview study

Sumpton, Daniel; Hannan, Elyssa; Kelly, Ayano; Tunnicliffe, David J.; Ming, Andrew; Hassett, Geraldine; Craig, Jonathan C.; Tong, Allison

doi:10.1007/s10067-020-05391-y

Cited by 6 publications

(11 citation statements)

References 37 publications

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“…A positive consequence of the pandemic was increased multi-disciplinary teamwork within hospitals. These enhanced professional relationships may facilitate long-term improvements in multi-disciplinary care, previously reported as ‘fragmented’ [ 37 ] for some rheumatology patients. Conversely, relationships between primary and secondary care had deteriorated, resulting in additional clinician stress and some patients being left without sufficient care from either.…”

Section: Discussionmentioning

confidence: 99%

Will ‘the feeling of abandonment’ remain? Persisting impacts of the COVID-19 pandemic on rheumatology patients and clinicians

et al. 2022

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Objective To better understand rheumatology patient and clinician pandemic-related experiences, medical relationships and behaviours in order to help identify the persisting impacts of the Covid-19 pandemic, and inform efforts to ameliorate the negative impacts and build-upon the positive ones. Methods Rheumatology patients and clinicians completed surveys (Patients N = 1,543, Clinicians N = 111) and interviews (Patients N = 41, Clinicians N = 32) between April 2021 and August 2021. A cohort (N = 139) of systemic autoimmune rheumatic disease patients was also followed-up from March 2020 to April 2021. Analyses used sequential mixed methods. Pre-specified outcome measures included the Warwick-Edinburgh Mental wellbeing score (WEMWBS), satisfaction with care, and healthcare-behaviours. Results We identified multiple ongoing pandemic-induced/increased barriers to receiving care. The percentage of patients agreeing they were medically supported reduced from 74.4% pre-pandemic to 39.7% during-pandemic. Ratings for medical support, medical-security and trust were significantly (p< 0.001) positively correlated with patient WEMWBS and healthcare-behaviours, and decreased during the pandemic. Healthcare-seeking was reduced, potentially long-term, including from patients feeling ‘abandoned’ by clinicians, and a ‘burden’ from Government messaging to protect the NHS. Blame and distrust were frequent, particularly between primary and secondary care, and towards the UK Government, whom <10% of clinicians felt had supported clinicians during the pandemic. Clinicians’ efforts were reported to be impeded by inefficient administration systems, and chronic understaffing, suggestive of the pandemic having exposed and exacerbated existing healthcare-system weaknesses. Conclusion Without concerted action—such as rebuilding trust, improved administrative systems, and more support for clinicians—barriers to care and negative impacts of the pandemic on trust, medical relationships, medical-security and patient help-seeking may persist longer-term. Trial registration This study is part of a pre-registered longitudinal multi-stage trial, the LISTEN study (ISRCTN-14966097), with later Covid-related additions registered in March 2021, including a pre-registered statistical analysis plan.

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Section: Discussionmentioning

confidence: 99%

Will ‘the feeling of abandonment’ remain? Persisting impacts of the COVID-19 pandemic on rheumatology patients and clinicians

et al. 2022

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“…In the future, particular biomarkers may be tested for each case in order to identify which biologic agent will likely be effective and which will cause complications [ 36 , 37 ]. Nevertheless, at the present moment, the key step for the proper management of psoriasis patients under biologic therapy includes the close collaboration between dermatologists and colleagues of other specialties [ 75 , 76 , 77 , 78 , 79 ]. For that reason, it was our main purpose to provide an overview on each class of biologic agents, as well as on the most frequent adverse events they may cause in psoriasis patients with concomitant diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Psoriasis is a systemic, chronic, inflammatory condition associated with a wide range of comorbidities, namely psoriatic arthritis, non-alcoholic fatty liver disease, inflammatory bowel disease, cardiovascular risk (metabolic syndrome, obesity, hypertension, hyperlipemia), chronic kidney disease, and psychological disorders such as anxiety and depression [ 75 ]. Concerning psoriatic arthropathy, a recent interview study from 2021 by Sumpton Daniel et al on the perspective of the clinicians of a shared care of psoriatic arthritis and psoriasis between dermatology and rheumatology found that shared care models may improve the accuracy of management by making the patient the center of care [ 76 ]. In 2018, a position statement on the management of psoriasis patients with concurrent diseases was published [ 75 ].…”

Section: Complications Of Biologic Therapy and The Importance Of A Mu...mentioning

confidence: 99%

Risks of Biologic Therapy and the Importance of Multidisciplinary Approach for an Accurate Management of Patients with Moderate-Severe Psoriasis and Concomitant Diseases

Ion

Dorobanțu

Popa

et al. 2022

Biology

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Psoriasis is a chronic multisystem inflammatory disease associated with a plethora of comorbidities including metabolic syndrome, cardiovascular disease, hypertension, diabetes, hyperlipidemia, obesity, anxiety, depression, chronic kidney disease, and malignancy. Advancement in unveiling new key elements in the pathophysiology of psoriasis led to significant progress in the development of biologic agents which target different signaling pathways and cytokines involved in the inflammatory cascade responsible for the clinical manifestations found in psoriasis. Currently available novel therapeutic options for moderate-severe psoriasis include tumor necrosis factor alpha inhibitors, inhibitors of the interleukin 17, and inhibitors of the interleukin 23. Nevertheless, concerns have been raised with respect to the possible risks associated with the use of biologic therapy requiring close collaboration between dermatologists and physicians of different specialties. Our aim was to perform an in-depth literature review and discuss the potential risks associated with biologic therapy in patients with psoriasis and concurrent diseases with a focus on the influence of novel therapeutic agents on liver function in the context of hepatopathies, particularly viral hepatitis. A multidisciplinary teamwork and periodic evaluation of psoriasis patients under biologic therapy is highly encouraged to obtain an accurate management for each case.

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“…Similarly, a smaller study in Brazil has shown 30.9% newly diagnosed PsA and 58.5% changes in treatment after multidisciplinary clinic care 20 . Care providers who have experience in multidisciplinary clinics from both specialties generally perceived that these clinics not only provide better care for patients, but also improve communication between specialties, providing a platform for career development and increased research opportunities 13 . Yet, apart from a few scattered reports, little is known about the actual benefits, challenges, and practical logistics of these multidisciplinary clinics 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Benefits of collaborative care in this setting include timely and accurate diagnosis of PsA, comprehensive assessment of both skin and joint conditions, a coordinated treatment approach for patients with both PsA and PsO, thereby leading to improved outcomes, and patient satisfaction 10,11 . The healthcare providers have also reported enhanced efficiency and communication between medical teams, as well as increased educational and research opportunities 10,12,13 . Given their novelty, the literature on well‐constructed outcomes of these collaborative care models is scarce, and no data from Asia have been reported.…”

Section: Introductionmentioning

confidence: 99%

Patient and learner experience in a new set up of a multidisciplinary dermatology‐rheumatology clinic care model for psoriatic arthritis

et al. 2022

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Objectives:We described the set-up of a new multidisciplinary psoriatic arthritispsoriasis (PsA-PsO) clinic incorporating service, education, and research between rheumatologists and dermatologists for PsA. We describe the patients' and learners' experience of this shared-care model. Methods:A PsA-PsO clinic was newly set up in 2019. Each patient was first seen by a trainee, followed by both a dermatologist and a rheumatologist simultaneously in the same consultation room. We collected patients' and learners' experience through self-administered surveys.Results: From May 2019 to January 2020, we collected data from 44 visits (55% new referrals, 45% follow up) from 30 patients: 22.7% were referred for diagnostic doubts, 77.3% were for therapeutic issues. Eight of the 10 patients referred for diagnosis had PsA confirmed. Medication changes occurred in 63.6% of visits; 63.6% of patients continued follow up in the PsA-PsO clinic, and 36.4% were discharged back to the original respective care. The median (interquartile range) rating of patient satisfaction of the care was 8 (7-8) out of 10; 96.1% of patients would "probably" or "definitely recommend" the care to others. From 20 learners, 95% reported the experience as "extremely" or "very" beneficial to training. The PsA-PsO clinic was suspended during the COVID-19 pandemic from February 2020 because of lack of available staff. The service was resumed gradually from May 2021. Conclusion:Despite challenges, we report the set-up of a new care model between dermatologists and rheumatologists for care of patients with psoriatic disease. The care model was well received by patients. Learners from various levels reported benefit from the learning experience.

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Clinicians’ perspectives of shared care of psoriatic arthritis and psoriasis between rheumatology and dermatology: an interview study

Cited by 6 publications

References 37 publications

Will ‘the feeling of abandonment’ remain? Persisting impacts of the COVID-19 pandemic on rheumatology patients and clinicians

Will ‘the feeling of abandonment’ remain? Persisting impacts of the COVID-19 pandemic on rheumatology patients and clinicians

Risks of Biologic Therapy and the Importance of Multidisciplinary Approach for an Accurate Management of Patients with Moderate-Severe Psoriasis and Concomitant Diseases

Patient and learner experience in a new set up of a multidisciplinary dermatology‐rheumatology clinic care model for psoriatic arthritis

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