BOSTON, Massachusetts—New research analyzing in-office conversations between dermatologists and psoriasis patients suggests that there is room for improvement in the overall content of the discussions, including information about the patient's symptoms and quality-of-life.¹

“New communication strategies may help meet the specific needs of dermatologists engaging in dialogue with psoriasis patients,” concluded study researcher Heidi C. Waters, MBA, of Centocor Ortho Biotech Services, LLC, in Horsham, Pennsylvania.

Video, audio of psoriasis visits show little attention to symptoms, QOL

In the study, researchers video- and audio recorded one scheduled doctor’s appointment for 24 patients visits who saw 1 of 12 dermatologists. Patients and physicians were also interviewed after the visit to see how they thought the appointment went, and whether their expectations were met.

On average, the dermatologists in the study had been in practice for about 15 years, and 9 of them were male. Patients had an average age of 53 and 63% of them were male. The most common time interval between appointments was 2 to 3 months, but most patients with psoriasis saw their doctors less frequently.

Almost all of the doctor’s visits were considered regular follow-up visits. Most appointments focused on medication management with minimal attention to symptoms, physical exam and treatment progress. On average, an appointment lasted 7:34 minutes and half of the visit comprised medication management and related issues such as side effects.

Symptoms garnered about 1 minute of airtime during these visits. During the post-visit interviews, 54% of doctors and 88% of patients said that the patients were negatively affected by their psoriasis. In half of the visits, a 50% reduction in plaque coverage was considered the measure of success, but a physical skin exam comprised just 4 seconds of the typical visit.

Translating psoriasis research into practice: Take your time, do it right

Neil Sadick, MD, a New York City–based dermatologist and clinical professor of dermatology at Weill Cornell Medical College, told MSKreport.com that the new report calls attention to the fact that dermatologists need to do a better job of listening to, and educating, their psoriasis patients.

“Better patient education is needed,” he said. “A lot of doctors use physician extenders like physician assistants and nurse practitioners who also need to spend more time educating patients on the appropriate use of their medication.” This education may involve passing on helpful tips such as increasing the efficacy of topical medication by hydrating the skin before applying the therapy.

“We have to make sure patients on biologics are well-monitored in terms of blood tests,” Dr. Sadick said, adding that psoriasis patients taking biologic drugs may need longer appointments so their doctors can better manage all the ancillary issues that arise with these medications.

“We need to do routine full body exams of these patients that focus on the psoriasis areas, but also skin cancer among patients on phototherapy or immunosuppressant therapy,” he said. Such patients need a full body exam 2 to 3 times a year.

Dr. Sadick said that psoriasis patients also experience depression and other psychological problems due to their disease, so clinicians should put some time put aside to ask patients about emotional aspects of their disease.

“Patients should be monitored by internists on a yearly basis for hypertension and cardiovascular diseases and if they are on immunosuppressive or biologic therapy, we need to be sure there is no lymphoma or other neoplasm,” Dr. Sadick said.

Reference

1. Waters HC. Patient-Physician dialogue on the management of moderate-to-sever psoriasis. Presented at: American Academy of Dermatology’s Summer Academy Meeting 2009. July 29-August 2, 2009; Boston, Mass. P2310.