A prospective randomized controlled trial of patient‐initiated care. (1st August 2018)

• Record Type: Journal Article
• Authors: Khoury, L.R.; Møller, T.; Zachariae, C.; Skov, L.
• Is Part Of: British journal of dermatology. Volume 179:Number 2(2018)
• Page Start: e107
• Page End: e107
• Publication Date: 2018-08-01
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.16961
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Psoriasis is a chronic inflammatory skin condition. People with more severe psoriasis, on long‐term medication, need regular hospital check‐ups and blood tests. Clinic attendance is time‐consuming, affecting work or school and adding to the burden of disease. This Danish study looks at whether there is any disadvantage in patients requesting appointments themselves when they need them, rather than following a regime of regular, pre‐booked attendances. One hundred and fifty adult patients, known to be compliant with treatment, with psoriasis that was well‐controlled on the medicines methotrexate, acitretin or biologic agents, were randomly allocated to one of 2 groups. All had blood tests and collected medication every 12‐16 weeks; half were sent a clinic appointment every 12‐16 weeks while the other half were responsible for arranging their own tests, medicine collection, and consultations as required (patient‐initiated care consultations, PICCs) via a telephone helpline managed by specialized nurses who could also provide general advice and assistance. At the end of one year there was no difference between the groups in psoriasis severity, adverse events, dermatology‐related quality of life measures or satisfaction with healthcare. Patients in the PICC group requested 69% fewer clinic consultations but their adherence to treatment and monitoring were just as good as those being seen regularly and they missed fewer appointments: patients with regular appointments missed 29% compared with 6.9% in the PICC group. The authors conclude that PICCs reduce inappropriate follow‐up, free up resources for further in‐depth consultations and are welcomed by patients, at least those in this clinic population.