Phone-a-Friend: Exploring the Collaborative Care Model in Psoriasis

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Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of The Dermatologist or HMP Global, their employees, and affiliates. 

More than 8 million people in the United States are affected by psoriasis, including an estimated 600,000 people who are undiagnosed. Psoriasis is recognized to be an immune-mediated inflammatory disease, where the underlying systemic inflammation can manifest in multiple comorbidities, including psoriatic arthritis, cardiovascular disease, metabolic syndrome, and inflammatory bowel disease. Individuals living with psoriatic disease also struggle with mental health challenges resulting in a negative impact on overall quality of life. As a result of the associated psychosocial, emotional, and physical manifestations, psoriasis can be challenging to treat. 

“There are many comorbidities associated with psoriasis, with common ones being psoriatic arthritis and metabolic syndrome. The former often requires dermatologists to collaborate with rheumatologists to optimize therapeutic management of both the skin and joints. And for the latter, so many aspects of metabolic syndrome require coordinated care with primary care providers. These include optimal management of obesity, hyperlipidemia, diabetes, and hypertension, with an overall goal of reducing cardiovascular risk. Indeed, dermatologists are central in educating psoriasis patients on comorbidities, while initiating and encouraging proper follow-up with medical care collaborators,” according to Andrew Blauvelt, MD, MBA, National Psoriasis Foundation (NPF) medical board chair and owner of Blauvelt Consulting, LLC. 

This type of collaborative care approach is beneficial for health outcomes,¹ but working within it may not be intuitive. To help navigate this new dynamic, we sat down with G. Michael Lewitt, MD, NPF Collaborative Care in Psoriatic Disease program co-chair and dermatologist at Illinois Dermatology Institute, to ask him for his expert insights. 

Importance of Collaborative Care 

“It is okay if there are multiple cooks in the kitchen, as long as we are making the same thing. Many of the disease states we treat have comorbidities and nuances that cross over into other specialties. It is important as a dermatologist to have awareness of these, but we may not always have the up-to-date knowledge to treat. That being said, it is the communication between the collaborators that makes the world go round,” says Dr Lewitt. Furthermore, it is understood that collaborative care can positively affect patient outcomes and satisfaction. “Patients are often very grateful knowing that behind-the-scenes providers who care about them are talking about/coordinating their care.” 

Collaborative care is beneficial for a variety of reasons, including improved partnerships between specialties and within practices for patients with complex diseases, increased professional development, and unique training opportunities to learn the importance of communication between patients and all their providers.² “My favorite collaborating rheumatologist gave me screening tips for psoriatic arthritis. With those tips, I was able to transition a patient with persistent enthesitis from one agent that cleared his skin to one that did this and nearly eliminated morning pain, allowing him to return to his pastimes,” shares Dr Lewitt. But the collaboration expands beyond just the health care team. Dr Lewitt explains that he actively involves patients and their families, informing them he cares about their physical and mental health beyond the scope of their dermatologic condition. “I want to see them taken care of in a reactive and proactive manner.” 

For providers who want to integrate collaborative care into their practice, Dr Lewitt suggests they have a “speed dial” with providers across other specialties who are like-minded but also not afraid to challenge or augment the approach for the betterment of the patient. “But make sure you return the favor,” he adds. 

Learning More About Collaborative Care 

Beyond having a network of providers that one can reach out to, NPF holds a collaborative care educational program twice a year, Collaborative Care in Psoriatic Disease, which Dr Lewitt is cochairing this year. “For an educational program, it is extremely important to have a broad array of specialty providers present. Different perspectives are instrumental in developing care for patients,” offers Dr Lewitt. This also serves a dual purpose to help inform and educate about comorbidities that may be present in patients living with psoriatic disease. Dr Lewitt imparts, “Whenever I have the privilege of attending or, in this case, planning, I am excited to ask questions. For example, a rheumatologist helping me with elementary questions to ask and teaching me how to do a psoriatic arthritis screening exam that may prompt me to use an agent to treat/protect the joints and also when/if referral is needed or recommended.” 

This year, attendees can expect to interact with experts in psoriatic disease, learn examination tips, review systems, and ask questions that may elicit answers to positively impact care. Excitingly, part of the agenda will include reviewing patient cases and hearing from each of the specialists. 

“This unique program has had an impact on how clinicians interact with each other and their patients. As a result of participating in this program, participants report an improved ability to employ a shared management approach for the care of patients with psoriatic disease,” states Stephanie Corder, ND, RN, CHCP, director of medical affairs at NPF. 

Dr Lewitt advises, “If you have the ability, try to attend a program like this at your next national or local continuing medical education meeting and don’t be afraid to ask questions. Showing up and learning something while making new professional relationships is so important.” 

References 
1. Soleymani T, Reddy SM, Cohen JM, Neimann AL. Early recognition and treatment heralds optimal outcomes: the benefits of combined rheumatology-dermatology clinics and integrative care of psoriasis and psoriatic arthritis patients. Curr Rheumatol Rep. 2018;20(1):1. doi:10.1007/s11926-017-0706-0 

2. Okhovat JP, Ogdie A, Reddy SM, Scher JU, Merola JF. Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network Consortium (PPACMAN) survey: benefits and challenges of combined rheumatology-dermatology clinics. J Rheumatol. 2017;44(5):693-694. doi:10.3899/jrheum.170148