Providing optimal Psoriasis care in Primary care settings: Bridging care gaps by responding to healthcare professionals’ educational needs

By Dr. Gooderham

Keeping up to date with treatment options and other resources is key for healthcare professionals (HCPs) but challenging given the overwhelming heaps of data that need to be reviewed. One such challenge is for primary care professionals to keep up to date with latest treatment guidelines, given the large spectrum of conditions they manage.

A recent 2021 publication highlights the results from a mixed-methods study conducted with 380 HCPs in Canada and the US to assess the practice gaps and challenges faced in the care of patients with psoriatic diseases. Dermatologists’ , rheumatologists’ , primary care physicians’ [PCP], physician assistants’ [PA] and nurse practitioners’ [NP] insights were obtained through interviews and surveys. The aim was to help inform and develop educational activities that would improve the diagnosis, treatment and management of patients with psoriasis.

In this study, 81% NPs, 95% of PAs and 83% of PCPs reported limited knowledge of current guidelines for the treatment and management of psoriasis. Similar gaps were reported regarding the knowledge of the efficacy of available psoriasis treatment.

Diagnostic tools were not frequently used nor available in the primary care setting, and screening for sub-type of psoriasis at diagnosis was less frequently performed (30% of PCP, PA, and NPs are screening for psoriasis sub-types at diagnosis compared to 88% of Dermatologists and 65% of Rheumatologists). Indicators of the condition were often not clear for many HCPs which led to lower confidence levels particularly in PCPs and PAs.

The healthcare team also plays a key role in the management of medication side effects. To do so, HCPs need the resources and core knowledge to provide patients with education on their condition and the impact of new treatments for psoriasis. This way, they can empower patients in the co-management of their condition. In this study, an average of 73% of PCPs and 39% of specialists reported lacking knowledge of medical resources to educate patients on psoriatic diseases. In addition, 69% of PCPs reported lacking skills to communicate with and educate patients on treatment plans, explaining the impact of treatment on their immune system (79%), or their existing metabolic conditions (88%). Seventy-seven percent of PCPs, 85% of PAs, and 78% of NPs also reported challenges managing patients’ adherence to treatment in the presence of treatment side effects.

In addition, HCPs reported lacking skills to address patient expectations in absence of a cure, and to counsel patients on psychosocial issues. Over half of PCPs and almost a third of dermatologists reported sub-optimal skills in making patients comfortable when discussing emotional aspects of psoriasis.

Communication challenges were not only reported with patients, but also within the multidisciplinary team. “Good communication is the bridge between confusion and clarity” (Nat Turner). This study brought to light difficulties in determining which information to share with other HCPs when co-managing patients, as well as through which means.

Improvements can be made when challenges are recognized. This study identified educational needs of HCPs involved in psoriasis care that could have repercussions on accurate and timely diagnosis of the condition, treatment initiation, side effect monitoring, and continuity of care. Findings provide a starting point for clinicians to reflect on their practice and for the improvement of continuing professional development interventions that would bridge these gaps.

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Article Details
Healthcare Providers Face Numerous Challenges in Treating Patients with Psoriasis: Results from a Mixed-Methods Study
Suzanne Murray, Jeffrey Crowley, Melinda J. Gooderham, Alan Kivitz, Vinod Chandran, Sophie Péloquin, Paul P. Doghramji, Christie Freeman, and Patrice Lazure
First Published December 7, 2021
DOI: 10.1177/24755303211062887
Journal of Psoriasis and Psoriatic Arthritis

About the Author

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Dr. Gooderham is a Dermatologist and Medical Director at the SKiN Centre for Dermatology and an Investigator with Probity Medical Research. She is an Assistant Professor at Queens University and a Consultant Physician at the Peterborough Regional Health Centre. She is a fellow of the Royal College of Physicians and Surgeons of Canada. Dr. Gooderham has been the principal investigator for 190 clinical trials and she practices with a focus on inflammatory diseases of the skin. She also contributes to several peer-reviewed dermatology publications as an associate editor, reviewer, and has been an author of 150 articles. She enjoys lecturing to global audiences on new therapies for skin diseases.