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Managing Patients With Psoriasis in the Busy Clinic: Practical Tips for Health Care Practitioners.

ABSTRACT: Psoriasis is a common inflammatory disease with significant comorbidities, whose management can be challenging given the variety of treatment options. It is critical for nurse practitioners, physician assistants, general practitioners, and dermatology trainees to have useful information about the treatment and monitoring of patients with psoriasis. Although certain aspects of care apply to all patients, each therapeutic agent has its own nuances in terms of assessments, dosing, and monitoring. The most appropriate treatment is based not only on disease severity but also on comorbid conditions and concomitant medications. These practitioners are vital in facilitating patient care by thorough understanding of systemic agents, selection criteria, dosing, and recommended monitoring. This article provides high-yield practical pearls on managing patients with moderate to severe psoriasis. It includes case-based discussions illustrating considerations for special populations, such as pregnant women, children, and patients with comorbidities (eg, human immunodeficiency virus infection, hepatitis C, hepatitis B, and history of malignancy).

SUBMITTER: Armstrong AW

PROVIDER: S-EPMC4834511 | biostudies-other | 2016 May

REPOSITORIES: biostudies-other

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Managing Patients With Psoriasis in the Busy Clinic: Practical Tips for Health Care Practitioners.

Armstrong April W AW Aldredge Lakshi L Yamauchi Paul S PS

Journal of cutaneous medicine and surgery 20151228 3

Psoriasis is a common inflammatory disease with significant comorbidities, whose management can be challenging given the variety of treatment options. It is critical for nurse practitioners, physician assistants, general practitioners, and dermatology trainees to have useful information about the treatment and monitoring of patients with psoriasis. Although certain aspects of care apply to all patients, each therapeutic agent has its own nuances in terms of assessments, dosing, and monitoring. T ...[more]

PMID: 26712930

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Project description:BackgroundIn the UK, chronic disease, including chronic kidney disease (CKD) is largely managed in primary care. We developed a tool to assess practitioner confidence and knowledge in managing CKD compared to other chronic diseases. This questionnaire was part of a cluster randomised quality improvement interventions in chronic kidney disease (QICKD; ISRCTN56023731).MethodsThe questionnaire was developed by family physicians, primary care nurses, academics and renal specialists. We conducted three focus groups (n=7, 6, and 8) to refine the questionnaire using groups of general practitioners, practice nurses and trainees in general practice. We used paper based versions to develop the questionnaire and online surveys to test it. Practitioners in a group of volunteer, trial practices received the questionnaire twice. We measured its reliability using Cohen's Kappa (K).ResultsThe practitioners in the focus groups reached a consensus as to the key elements to include in the instrument. We achieved a 73.1% (n=57/78) initial response rate for our questionnaire; of these 57, 54 completed the questionnaire a second time. Family physicians made up the largest single group of respondents (47.4%, n=27). Initial response showed more female (64.9%, n=37) than male (35.1%, n=20) respondents. The reliability results from retesting showed that there was moderate agreement (k>0.4) on all questions; with many showing substantial agreement (k>0.6). There was substantial agreement in the questions about loop diuretics (k=0.608, CI 0.432-0.784, p<0.001), confidence in managing hypertension (k=0.628, 95%CI 0.452-0.804, p<0.001), diastolic blood pressure treatment thresholds in CKD (k=0.608, 95%CI 0.436-0.780, p<0.001) and the rate of decline of eGFR that would prompt referral (k=0.764, 95%CI 0.603-0.925, p<0.001).ConclusionThe QICKD-CCQ is a reliable instrument for measuring confidence and knowledge among primary care practitioners on CKD management in the context of UK primary care.

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Managing Patients With Psoriasis in the Busy Clinic: Practical Tips for Health Care Practitioners.

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Managing Patients With Psoriasis in the Busy Clinic: Practical Tips for Health Care Practitioners.

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