Addressing Disparities in Care for Psoriasis

Bruce Sherman, MD, FCCP, FACOEM, and Maria Lopes, MD, MS, discuss how organizations can address disparities in care for psoriasis.

Ryan Haumschild, PharmD, MS, MBA: Dr Sherman, how can organizations address disparities in care for psoriasis, specifically the minority patient populations that we spoke about earlier? What should be the main focus of the interventions we’re working on?

Bruce Sherman, MD, FCCP, FACOEM: Good question. I sense awareness is probably one of the biggest issues and destigmatization of psoriasis as a condition so that individuals affected by these conditions feel more comfortable seeking care. I think when issues are potentially patient-generated, perhaps clinicians will be more likely to take note. That said, the challenge is that individuals and minorities experience implicit bias. We’ve heard about other concerns relating to those conditions where quality metrics are paramount in terms of payment models, so “Let me focus more on your diabetes than on your psoriasis or your obesity.” I think it requires a comprehensive effort. I don’t think there’s any single component that is necessarily going to solve the problem. Certainly, enhancing patient awareness of a condition they may have, encouraging them to seek care, and raising the question with their clinician, is at least a substantial first step.

Ryan Haumschild, PharmD, MS, MBA: Absolutely, I think that’s a great first step we all can take part in. Developing equitable treatment interventions is extremely important. We’ve talked a lot about the pharmaceutical or the medication interventions we can work on, but we know that extends beyond that to devices. Dr Lopes, a study by some of our colleagues at the Harvard Medical School found that devices like pulse oximeters may contribute to disparities in care based on a patient’s race. How can we as health care providers ensure that medical devices are built and accurate for patients of all races and all ethnicities?

Maria Lopes, MD, MS: That’s a really important question that probably takes us back to even enrolling patients into clinical trials. As we look at different social, racial, and ethnic backgrounds, an important question for a clinical trial is, do we have adequate makeup from every race so that we can glean…? This is true of medications as well. Do we have confidence in the clinical trials in terms of the ethnic makeup that allows us to answer some of these important questions? I think even on the device side, many times devices come to market without a lot of data, they follow a different trial path, [a different] FDA clearance path, so how much do we know? There are a lot of questions that are unanswered about the ease of use. Dr Sherman talked about that earlier, the trust that patients often have around the collection of the data and what they mean. Also, are we getting at the right questions that hopefully can be answered through data that help us all do better in terms of what’s the appropriate intervention that follows a better understanding of what patients are really thinking and what matters to them.

Ryan Haumschild, PharmD, MS, MBA: The data is so important because that allows us to develop new strategies to really understand what’s going on with the patient, beyond just what we think we know, but real data that relate to the patient.

Transcript edited for clarity.

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