Maria Lopes, MD, MS, reviews how to educate providers on the risks and burdens of psoriasis and how to improve early diagnosis and treatment for all skin phototypes and ethnicities.
Ryan Haumschild, PharmD, MS, MBA: Let’s talk about addressing disparities in care and what future considerations look like. Dr Lopes, how are you educating providers on the risks and burdens of psoriasis for all skin phototypes and ethnicities? Are you doing anything at your organization to try to improve earlier diagnosis and treatment of psoriasis across all the skin phototypes we’ve talked about?
Maria Lopes, MD, MS: Payers aren’t doing enough. We’re relying on clinicians [because] patients often present to primary care providers [PCP]. [We need to] bring out best practices around education and making the diagnosis. I was struck by a comment Dr [Amy] McMichael made early on about the importance of a biopsy to make sure you’re dealing with the right diagnosis. With telehealth, there’s more opportunity to bring specialty care into the primary care world, which is going to be critical. A lot of these patients also develop psoriatic arthritis, so perhaps there’s an even greater need to involve specialists early on.
When you get to a biologic, payers often want to see that there’s a specialist involved or in consultation with a primary care practitioner to manage the care appropriately. This isn’t a quality measure, so it’s often not on the payer’s radar to be educating PCPs. We often rely on PCP awareness and referral patterns to be occurring, but there are access challenges. In many areas, particularly rural areas, we don’t have enough specialists. We never will. How do we bring care into the home in terms of educating patients, but also how do we coordinate the care more holistically around the PCP environment and arrange or make referrals much easier in terms of patient care? There’s this gap in awareness, education, and treatment approach. How do we think about this algorithm? How do you package some of these best practices so that there’s greater awareness on both the patient side and the PCP side, in terms of what can be done and when a referral is necessary?
Ryan Haumschild, PharmD, MS, MBA: You talked about PCP. That’s so important. Dermatologists do an incredible job managing patients, but they’re not everywhere. Sometimes they’re not in the communities where these patients live. These patients may know their primary care provider closely. They might look to them for the management of their comorbidities and their primary diagnosis of psoriasis. What can we do differently in primary care offices to prevent patients from having that delayed diagnosis and allow treatment to start earlier?
Maria Lopes, MD, MS: Early diagnosis matters in terms of a treatment approach. If we wait for later, when the disease is more moderate to severe, the costs are going to be higher and the implications for total cost of care are going to be higher. It’s about early identification and setting patient expectations. Getting them on the appropriate treatment may be very low cost at that point. Everyone benefits in that scenario. Also, I wonder how often misdiagnosis occurs. The biopsy is clarifying. Do you have lupus or psoriasis? What type of skin condition do you actually have that dictates the appropriate treatment? How much are we missing out on not having more education directed at the PCP? [Even if they’ve been] following these patients for years, they may not be aware that these patients have psoriasis or may not be aware that this matters to patients. Education is fundamental to the whole process.
[We also need to] get physicians and PCPs comfortable with this same type of dialogue to match the patient to treatment options that are reasonable and appropriate, to know when to escalate treatment and feel comfortable with this paradigm. Many of them may not feel comfortable prescribing biologics. Also, payers may have rules at that point in terms of when the patient has to be assessed by a specialist.
Transcript edited for clairty.