Alexis Ogdie, MD, on Combined Clinics — Combined Goals

Dr Ogdie gives a review of her presentation at the 2022 Interdisciplinary Autoimmune Summit, with Dr Joseph Merola, on the benefits of combined clinics for treating patients with autoimmune disorders.

Alexis Ogdie, MD, is Associate Professor of Medicine and Epidemiology in the Perelman School of Medicine. She is also Deputy Director of the Center for Clinical Epidemiology and Biostatistics and Director of the Penn Psoriatic Arthritis and Spondyloarthritis Program.

TRANSCRIPT

Alexis Ogdie, MD:
Hi, my name is Alexis Ogdie. I'm associate professor of medicine and epidemiology at the University of Pennsylvania. Recently, we had the interdisciplinary autoimmune summit this past weekend and I gave a talk in combination with Joe Merola fro, Brigham and Women's Hospital. We talked about combined clinics and we call it combined clinics, combined goals. So, hopefully, you get to watch the talk on the platform, but I'll distill it down into a few-minute summary of what we talked about.

First of all, one of the goals of this presentation was just to kind of talk about what's out there in terms of combined clinics, what kinds of combined clinics have been developed. So Dermatology and rheumatology—I'm a rheumatologist, he's a dermatologist. Rheumatologists are the ones that we're most familiar with. Within dermatology and rheumatology clinics they're set up in different ways across the country. Some people have a dermatologist and rheumatologists seeing patients together in the same room at the same time. We call that kind of a traditional combined clinic. And then, sometimes it's a virtual combined clinic where you might see the individual providers separately in the regular space and time.

But then, you talk about the patients together or you have that close connection with someone you can text when the patient's in the room and say, "Can we quickly discuss this thing about the patient and their treatment plan." These dermatology-rheumatology clinics may differ by institution in terms of what the focus is. For example, we have a psoriatic disease one here at Penn and so does Brigham. But, some of the other clinics are more connective tissue facing so they might focus on scleroderma and lupus and dermatomyositis, for example.

Even beyond dermatology and rheumatology, there are other types of combined clinics. For example, I think it's St. Louis they have an ophthalmology and rheumatology clinic. In other institutions, they have cardiology and rheumatology at University of Toronto, actually. There's GI combined clinics as well, I believe, so many different types of combined clinics. It doesn't have to be derm-rheum.

Why do we have to combine clinics or what's the concept underlying that? First of all, many of the autoimmune diseases that we treat are highly heterogeneous and they often involve multiple systems. When you're making decisions about the treatment of the patient as a whole, you want to consider the skin and the joints, for example, in psoriatic disease, or maybe you want to consider the cardiovascular implications of their lupus. There may be many different things that we want to try and think about, but as we make a treatment plan together.

Often, you need the other specialists to help you figure out exactly what the optimal treatment plan is. In my patients, when their joints are under really good control, but their skin is not under control, and it's very bothersome to them, it's really helpful to have the dermatologic input to say, "Well, we could try a little bit of light therapy for that." Or, "Maybe they should try this topical instead," or "No, we really need to switch therapy for this. We can't get better any other way." So having that discussion is really helpful for me as a provider. I also learn a lot that way. But it's also really helpful for the patient and actually gets the patient better care faster. And we think that this leads to better outcomes down the road for patients. It certainly leads to increased patient satisfaction as a couple of studies have demonstrated.

So, what are the different benefits of having a combined clinic? One is improved patient outcomes. One is improving the training of residents or fellows, for example, in those particular disciplines, then they get really comfortable with the other side. The other is training the physicians. I've learned a lot about dermatologic disease and some of my dermatology colleagues have learned a lot about rheumatologic disease just from our discussions. We also learn about practice patterns so we can streamline care. For example, if they have a patient with psoriasis they already know what I'm going to do on the first visit with the patient who has psoriasis and potential inflammatory arthritis. They get all that workup done before the patient comes to see me and then I can have an expedited plan because all of the work is done upfront. That can be really helpful in streamlining care as well. Additionally, we also share knowledge about the concomitant comorbidities, so we can think about other specialists that need to be in earlier as opposed to later.

And finally, I think just from a provider perspective, it's really rewarding to work with colleagues in a team, as opposed to running through your day by yourself all day, so having these discussions is a lot of fun. It really does take a team to be able to think about this whole patient approach. There might be many different things that we capture and we all each might do that in a different way. And if we're having a systematic approach to the patient through a combined clinic, we can kind of divide up those tests a little bit better. I may not need to focus on skin as much if my dermatologic colleague is going to be kind of really carrying that part. We talked a little bit in this talk about Joe Merola's clinic, the CSRM Clinic or the Center for Skin and Related Musculoskeletal diseases and how they operate their clinic.

We talked about this PPACMAN, our Psoriasis and Psoriatic Arthritis Multicenter Advancement Network. It's a 501c3 organization in which we're aiming to improve outcomes for patients through research, through education of providers, and also through providing the support needed to help develop these combined clinics. On our website ppacman.org, we have some materials about how to form a combined clinic and what are the different models that you can use. We have a document up there that kind of steps you through how to think through the process and how to present that to someone that you're going to have to sell this to. For example, your department chair, or division chief or business administrator to kind of think through what are the benefits and how can you sell this to them as something that you want to do?

We also talked about the research agenda and the many things that having combined clinics really serves. Not only does it serve the clinical care of the patients, the education of trainees and provider satisfaction, it also improves the opportunities for research that moves across different disciplines. Within this talk, we talked about the number of different studies that we have going on right now that are examining the transition from psoriasis to psoriatic arthritis and really these combined clinics are the optimal place to study that. And finally, we pointed to a couple EPIC templates we've developed through PPACMAN and we put those up on the website as well. You can find those under resources as well. There's a dermatologic one and a rheumatologic one for assessing psoriatic disease. These were pre pandemic, so they have vaccination stuff, but not updated since 2020. But, at least, there are nice EPIC templates that you can use and edit or modify for what you wanted to use. Hopefully, you'll get to view the talk on the platform, but otherwise I hope that you've gotten something out of this short snippet about this talk. Thanks so much for your attention.