‘On the surface’: a qualitative study of GPs’ and patients’ perspectives on psoriasis

Abstract

BackgroundPsoriasis is a chronic, inflammatory skin disease affecting approximately 2% of the UK population and is currently incurable. It produces profound effects on psychological wellbeing and social functioning and has significant associated co-morbidities. The majority of patients with psoriasis are managed in primary care, however in-depth patient and GP perspectives about psoriasis management in this setting are absent from the literature. This article reports an in-depth study which compares and contrasts the perspectives of people with psoriasis and of GPs on the challenges of managing psoriasis in primary care.MethodsIn-depth, qualitative semi-structured interviews were conducted with a diverse sample of 29 people with psoriasis and 14 GPs. Interviews were coded using principles of Framework Analysis to enable a comparison of patient and practitioner perspectives on key issues and concepts arising from the data.ResultsPatients perceived GPs to be lacking in confidence in the assessment and management of psoriasis and both groups felt lacking in knowledge and understanding about the condition. While practitioners recognised that psoriasis has physical, emotional and social impact, they assumed patients had expertise in the condition and may not address these issues in consultations. This resulted in patient dissatisfaction and sub-optimal assessment of severity and impact of psoriasis by GPs. Patients and GPs recognised that psoriasis was not being managed as a complex long-term condition, however this appeared less problematic for GPs than for patients who desired a shared management with their GP incorporating appropriate monitoring and timely reviews.ConclusionsThe research suggests that current routine practice for psoriasis management in primary care is mismatched with the expressed needs of patients. To address these needs, psoriasis must be recognised as a complex long-term condition involving exacting physical, psychological and social demands, co-morbidity and the development of new treatments.General practitioners need to improve both their knowledge and skills in the assessment and management of psoriasis. This in turn will facilitate management of the condition in partnership with patients. Commissioning multi-disciplinary services, which focus on long-term impacts on wellbeing and quality of life, might address current deficits in care.

The role of personal models in clinical management: Exploring health care providers’ beliefs about psoriasis

“…This finding is supported by previous research identifying similar language used by GPs (Nelson, Barker et al, 2013). This highlights limited uptake of current clinical recommendations to address psychological and social well-being, and lifestyle factors with patients with psoriasis (National Institute for Health and Care Excellence, 2012).…”

Nonadherence to psoriasis medication as an outcome of limited coping resources and conflicting goals: findings from a qualitative interview study with people with psoriasis

“…These challenges resulted in unresolved emotional distress, little perceived control and high levels of uncertainty. Findings reflected other evidence that highlighted perceived lack of support from healthcare providers, especially within general practice management,7, 33, 46 and in the current study this further undermined optimal medication usage.…”

Quality of life in psoriasis patients

“…Psoriasis affects health-related quality of life (HRQoL) to an extent similar to the effects of other chronic diseases such as depression, myocardial infarction, cancer and hypertension. The visible nature of psoriasis can be particularly disabling [2], with evidence of stigma, lowered self-image, depression, anxiety and suicidal ideation [3], even in mild psoriasis [4]. Especially on highly visible areas of the skin, psoriasis can be psychologically devastating [5].…”