A prospective 52-week randomised controlled trial of patient-initiated care consultations for patients with psoriasis

Abstract

Background

Treatment and care of moderate to severe psoriasis requires lifelong consultations with a dermatologist with close monitoring of systemic treatment.

Objectives

To investigate the effect of patient-initiated care consultations (PICC) for patients with psoriasis in a dermatology outpatient clinic.

Methods

A prospective randomised controlled trial with patients in well-controlled systemic treatment randomised to either 1) the PICC group, where they participated in one annual consultation with a dermatologist but were able to initiate consultations when needed; or 2) routine care, where they participated in a consultation every 12-16 weeks. The primary outcome was the Dermatology Life Quality Index (DLQI). Other outcomes were safety, patient adherence and satisfaction with healthcare assessed at baseline and after 52 weeks.

Results

150 patients were included, with 58.0% treated with biologicals, 37.3% with methotrexate and 4.7% with acitretin. At week 52 no statistically significant mean difference between groups was detected in DLQI 0.28 (95% CI, -0.35–0.9) or Psoriasis Area Severity Index -0.24 (95% CI, -0.84–0.36). Patients in the PICC group requested 63.1% fewer consultations with a dermatologist, mean ±SD 2.5 ±0.1 vs. 5.1 ±0.6, (p=0.001). Patient adherence and safety with treatment monitoring was equal between groups, but the PICC group was significantly better at attending consultations than the control group (p=0.003).

Conclusion

PICC offers additional clinical benefits compared to routine care, making patients less dependent on clinical visits. The intervention adds no harm to monitoring systemic treatment and patients report high quality of life and satisfaction with healthcare.

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