Dermatologists and Psoriatic Patients Show Interest in Specialist-Led CVD Prevention

John Barbieri, MD, MBA

A new study survey found that both dermatologists and patients with psoriatic disease expressed satisfaction with engaging in a specialist-led model of care for the improvement of cardiovascular disease (CVD) prevention.

Cardiovascular disease remains the leading cause of morality in patients with psoriatic disease. Despite this, many patients do not have active relationships with primary care physicians.

Investigators led by John Barbieri, MD, MBA, University of Pennsylvania, to hypothesized that specialist-led care for the prevention of CVD could aid in bridging the gap between patients and dermatologists, and sought to explore clinician and patient perspectives regarding strategies to improve CVD management through this type of care.

The Methods

Barbieri and colleagues issued a survey questionnaire to assess clinician perspectives on CVD management. The questionnaire included a series of items asking whether specialist-led screening and management of CVD risk was feasible.

The items featured in the survey were adapted from the validated Feasibility of Implementation Measure assessment, and a best-worst scaling choice experiment was included to elicit preference for 8 implementation strategies shown to be efficacious in increasing statin prescribing rates in primary prevention of CVD.

The 8 strategies were clinical decision support, patient educational materials, physician educational outreach, a telemedicine partnership to screen and manage dyslipidemia, peer coaching, a mobile app or texting service to remind patients to undergo CVD risk screening, a pay-for-performance option, and audit and feedback for comparison with peers.

To assess patient perspectives, investigators developed a questionnaire to measure the likelihood of engaging in relevant prevention behaviors such as having their cholesterol checked, incorporating therapeutic lifestyle changes, or taking a statin.

From there, participants were given scenarios in which either their primary care physicians or specialist were making these recommendations. From there, participants were asked whether they would prefer their specialist educate them on the risk of CVD and whether they would find it convenient for their specialist to check their cholesterol level.

The Findings

A total of 183 dermatologists had completed the clinician survey.

In response to the prompt, “I think checking lipids and calculating a 10-year cardiovascular risk score to determine if a statin is recommended seems doable,” 69.3% (95% CI, 62.2%-76.0%) of dermatologists (of which there were 106) agreed or strongly agreed with the statement.

In response to “I think prescribing statins when they are indicated based on guidelines for primary prevention of cardiovascular disease seems doable,” 36.1% (95% CI, 29.1%-43.5%) of dermatologists agreed or strongly agreed with the statement.

A majority of dermatologists (67.8%) also agreed or strongly agreed that they would change their practice to screen and manage CVD risk if a clinical trial demonstrated that patients achieved better CVD risk prevention when the specialist screened for cholesterol levels and prescribed statins.

Clinical decision support (preference score, 22.3; 95% CI, 20.7-24.0), patient education (preference score, 14.1; 95% CI, 12.5-15.7), and clinician education (preference score, 15.8; 95% CI, 14.3-17.3) were ranked as strategies likely to improve CVD prevention in patients with psoriatic disease among clinicians.

Additionally, 69.3% (95% CI, 62.2%-76.0%) of dermatologists agreed or strongly agreed that checking lipid levels was feasible.

Among 160 patients with psoriasis and 162 patients with psoriatic arthritis who responded to the survey, (226 [70.2%] women) patients reported they were as likely to engage in cardiovascular risk screening and management behaviors whether recommended by their primary care physician or their specialist.

Furthermore, 60.0% (95% CI, 52.0%-67.7%) of patients with psoriasis and 75.3% (95% CI, 67.9%-81.7%) with psoriatic arthritis agreed that it would be convenient for them to have their cholesterol checked by their dermatologist or rheumatologist.

“Future studies are needed to evaluate whether these implementation strategies can successfully be adopted and whether they can improve outcomes associated with CVD risk management among patients with psoriasis and psoriatic arthritis,” the team wrote.