Health Inequities Impacting Optimal Treatment for Patients With Psoriasis

Bruce Sherman, MD, FCCP, FACOEM, underlines the impact of health inequities for patients diagnosed with psoriasis.

Ryan Haumschild, PharmD, MS, MBA: Dr Sherman, we heard a lot of great things from Dr [Amy] McMichael. We heard a lot of good things about health equity, unique treatment strategies, and including the patient as part of the treatment plan. In your mind, in your experience, how does health inequity impact the diagnosis and the treatment of psoriasis across the different skin phototypes?

Bruce Sherman, MD, FCCP, FACOEM: Health inequities are essentially a setting where patients don’t have the optimal opportunity to live as healthy a life as they possibly can. Several factors contribute to those inequities. The challenge is that we’re just beginning to understand that they exist. We don’t have an appreciation of the magnitude or significance of those in different circumstances. For example, at the patient level, there may be issues. Dr McMichael alluded to medical mistrust, or stigma. There may be financial concerns. There may be a host of other factors at the patient level on social needs that may impact their ability to receive equitable care. Culturally, they may be different from the provider and may not be able to relate to or respond to that provider.

From the clinician’s standpoint, we’re only beginning to appreciate the magnitude of differences in different subpopulations. We’re all here to talk about individuals with psoriasis and individuals with different skin types. If we aren’t able to acknowledge the unique differences, not only in the phototypes but also in the cultural beliefs and perhaps affordability concerns or unmet social needs, then those individuals are likely going to receive suboptimal care. The focus needs to be on prompt, timely diagnosis and effective, directed treatment toward the individual with particular concerns, taking their broader circumstances and situation into context. This is the direct answer to your question: inequities result in misdiagnosis or delayed diagnoses, as well as the risk of potential undertreatment for individuals.

Ryan Haumschild, PharmD, MS, MBA: You highlight a lot of things. Undertreatment is 1 of the scariest things for a lot of patients, especially if they feel their clinician is not listening to them, or feel like they aren’t a part of that plan. Ultimately, if they’re not adhering or if they’re not seeing a resolution of symptoms, they may pursue other treatments or become less motivated for the plan of care. Those are great things to highlight.

Transcript edited for clarity.

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