Combined Clinics – Treating Patients as a Whole

Dr Joseph F Merola, MD, MMSc and Dr Alexis Ogdie, MD, MSCE got together to discuss combined clinics and touched base on “accessing the role of interdisciplinary care in optimizing disease outcomes and then understanding how combined approaches to both clinical care and research may improve outcomes for patients.”

Dr Ogdie kicked off the session by explaining the concept of combined clinics: “multidisciplinary clinics that combine one or more disciplines… rheumatology and dermatology are some of the most common combined clinics.”

Dr Merola added that for psoriatic diseases ‘a bit of complicated approach makes sense.” He differentiates the psoriatic diseases approach from both sides: for the dermatologist’s side, “Dermatologists are less familiar with the joints exam and differential diagnosis of articular disorders.” And from the rheumatologist’s side, “Rheumatologists often underestimate [the] importance of skin disease activity and may not be familiar with multiple presentations of psoriasis and [differential diagnosis] of skin lesions.”

The discussion turned to treating patients as a whole. Dr Ogdie pointed out that they treat the whole patient and not just their part of the disease. Some of the things they consider are skin and nail disease, specialty pharmacist, primary care, emotional wellbeing, work, family and friends, sleep, fatigue, exercise and muscle balance, and diet.

Dr Merola explained the concept of treating the whole patient: “At least at the minimum, we own the pieces that we own and then also own getting the patient plugged in with the right people and resources to get that whole treatment approach happening, even if it’s not happening in our office, but it’s happening in collaboration with other specialties so that [patients] are getting the best care.”

Additionally, Dr Merola explained a combined clinics which included dermatologists and rheumatologists. The KPMG – GRAPPA project has four phases: pre-diagnosis, referral and diagnosis, treatment initiation and management, follow-up and treatment of comorbidities. The combined clinic model SARM: the Center for Skin and Related Musculoskeletal Diseases had benefits to patients and educational/academic benefits: "Benefits to patients included education and support, one-stop shopping, access to a wider array of therapies, combined discussion with the patient, quicker transition to appropriate systematic DMARDs." He further added for education / academic benefits, “Providers: increased collegiality, cross-disciplinary education, and work satisfaction; clinical research and trails; rheumatology fellows: dermatology differential diagnosis, use of topicals, etc.; dermatology residents: rheum exam/work-up, comfort with systematic agents, etc.”

Dr Ogdie informed about one of the non-profit combined clinics called PPACMAN, Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network Consortium and explained its mission to “optimize the clinical care of patients with [the] psoriatic disease through multi-disciplinary collaboration, education, and innovative research.”

Dr Merola pointed out that “the key ingredient among various models of collaborative care is facilitated communication.”

Dr Merola and Dr Ogdie concluded the session and shared some useful resources they created for combined clinics like PPACMAN EMR Toolkit (EPIC format). “We created a set of documents, to help clinicians who’re thinking about putting together a combined clinic, about all the things that they might need to know. It even has some talking points to your department chair… so this is a very helpful document to download off the webpage.”

Reference
Merola JF, Ogdie A. Combined clinics - combined goals. Presented at: Interdisciplinary Autoimmune Summit; April 9–11, 2022; Virtual.