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

BackgroundTreatment and care of moderate-to-severe psoriasis require lifelong consultations with a dermatologist with close monitoring of systemic treatment. ObjectivesTo investigate the effect of patient-initiated care consultation (PICC) for patients with psoriasis in a dermatology outpatient clinic. MethodsA prospective randomized controlled trial with patients on well-controlled systemic treatment randomized to either (i) the PICC group, where they participated in one annual consultation with a dermatologist but were able to initiate consultations when needed; or (ii) 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. The study was registered with clinical trials number NCT02382081. ResultsIn total 150 patients were included, with 58<bold></bold>0% treated with biologics, 37<bold></bold>3% with methotrexate and 4<bold></bold>7% with acitretin. At week 52 no statistically significant mean difference between groups was detected in DLQI (0<bold></bold>28, 95% confidence interval -0<bold></bold>35 to 0<bold></bold>9) or Psoriasis Area and Severity Index (-0<bold></bold>24, 95% confidence interval -0<bold></bold>84 to 0<bold></bold>36). Patients in the PICC group requested 63% fewer consultations with a dermatologist: mean 2<bold></bold>5 0<bold></bold>1 vs. 5<bold></bold>1 0<bold></bold>6 (P = 0<bold></bold>001). Patient adherence and safety with treatment monitoring were equal between groups, but the PICC group was significantly better at attending consultations than the control group (P = 0<bold></bold>003). ConclusionsPICC offers additional clinical benefits over 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. What's already known about this topic? Patients with moderate-to-severe psoriasis often need systemic treatment that requires lifelong monitoring. Well-treated patients report that routine consultations are burdensome because they are time consuming, affecting work or school. Failure to deliver the right care at the right time in the right place contributes to 40% of healthcare spending. What does this study add? Patient-initiated care consultations (PICCs) offer some clinical benefits compared with routine care, giving patients more flexibility and less dependence on clinical visits. PICCs add no harm to monitoring systemic treatment, and high patient-reported quality of life and satisfaction with healthcare are consistent. PICC releases resources to allow a more patient-centred approach to dermatology services by avoiding unnecessary consultations, providing more time to support patients during vulnerable periods, and reducing psoriasis relapse and comorbidity risk.