The Management of Psoriatic Arthritis in Italy: Organizational Impact Analysis of Optimized Pathwaystimized pathways

Umberto Restelli, Carlo Selmi, Valeria Pacelli, Davide Croce, Antonio Costanzo

DOI: https://doi.org/10.7175/fe.v20i1.1427

Abstract

BACKGROUND: The management of psoriatic arthritis requires competencies in the fields of both rheumatology and dermatology, and a multidisciplinary approach.

AIM: To propose an effective pathway for the diagnosis, monitoring and treatment of psoriatic arthritis in the Italian context, and to assess its organizational impact on the Regional Health Service of Lombardy Region.

METHODS: The analysis was performed through interviews conducted with two key opinion leaders in the areas of dermatology and rheumatology. The current pathway of patients who present symptoms that might be related to psoriatic arthritis was defined and an optimized pathway was then proposed on the basis of the clinical practice, considering the implementation of a dermatology and rheumatology shared outpatient service. The organizational impact of the optimized pathway was then assessed from both the hospital and that of the Regional Health Service of Lombardy Region perspectives.

RESULTS: The implementation of the service would have a positive impact on patients’ experience, improving the quality of the service provided, thanks to the multidisciplinary approach adopted, limiting the patients’ resources needed for the diagnosis, reducing the number of visits and time loss. The optimized pathway, therefore, would have a limited impact on the marketing mix, while potentially improving patients satisfaction, increasing the possibility of patients’ retention. To successfully implement the dermatological and rheumatologic multidisciplinary service, a precise communication strategy is mandatory.

CONCLUSIONS: The optimized pathway for the diagnosis and management of psoriatic arthritis proposed would have a limited organizational impact at both hospital and Regional Health Service levels, while leading to theoretical benefits in terms of a prompt diagnosis of the pathology.

Keywords

Psoriatic arthritis; Multidisciplinary service; Organizational impact

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References

  • Bowcock AM, Cookson WO. The genetics of psoriasis, psoriatic arthritis and atopic dermatitis. Hum Mol Genet 2004; 13: R43-55; https://doi.org/10.1093/hmg/ddh094
  • de Vlam K, Lories RJ. Remission in psoriatic arthritis. Curr Rheumatol Rep 2008; 10: 297-302; https://doi.org/10.1007/s11926-008-0048-z
  • Dhir V, Aggarwal A. Psoriatic arthritis: a critical review. Clin Rev Allergy Immunol 2013; 44: 141-8; https://doi.org/10.1007/s12016-012-8302-6
  • Mortezavi M, Thiele R, Ritchlin C. The joint in psoriatic arthritis. Clin Exp Rheumatol 2015; 33: S20-5
  • Veale DJ, Fearon U. The pathogenesis of psoriatic arthritis. Lancet 2018; 391: 2273-84; https://doi.org/10.1016/S0140-6736(18)30830-4
  • Scotti L, Franchi M, Marchesoni A, et al. Prevalence and incidence of psoriatic arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2018; 48: 28-34; https://doi.org/10.1016/j.semarthrit.2018.01.003
  • Prignano F, Rogai V, Cavallucci E et al. Epidemiology of Psoriasis and Psoriatic Arthritis in Italy-a Systematic Review. Curr Rheumatol Rep 2018; 20: 43; https://doi.org/10.1007/s11926-018-0753-1
  • Hellgren L. Association between rheumatoid arthritis and psoriasis in total populations. Acta Rheumatol Scand 1969; 15: 316-26; https://doi.org/10.3109/rhe1.1969.15.issue-1-4.40
  • Hoff M, Gulati AM, Romundstad PR, et al. Prevalence and incidence rates of psoriatic arthritis in central Norway: data from the Nord Trøndelag health study (HUNT). Ann Rheum Dis 2015; 74: 60-4; https://doi.org/10.1136/annrheumdis-2013-203862
  • Salaffi F, De Angelis R, Grassi W; MArche Pain Prevalence; INvestigation Group (MAPPING) study. Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study. I. The MAPPING study. Clin Exp Rheumatol 2005; 23: 819-28
  • De Angelis R, Salaffi F, Grassi W. Prevalence of spondyloarthropathies in an Italian population sample: a regional community-based study. Scand J Rheumatol 2007; 36: 14-21; https://doi.org/10.1080/03009740600904243
  • Cimmino MA, Zampogna A, Murroni S, et al. Methodology of an epidemiologic prevalence study in rheumatology: the Chiavari study. Reumatismo 2002; 54: 40-7; https://doi.org/10.4081/reumatismo.2002.40
  • EUnetHTA Joint Action 2, Work Package 8. HTA Core Model ® version 3.0 (Pdf); 2016. Available at www.htacoremodel.info/BrowseModel.aspx (last accessed November 2018)
  • Souza CS, de Castro CCS, Carneiro FRO, et al. Metabolic syndrome and psoriatic arthritis among patients with psoriasis vulgaris: Quality of life and prevalence. J Dermatol 2019; 46: 3-10; https://doi.org/10.1111/1346-8138.14706
  • Truong B, Rich-Garg N, Ehst BD, et al. Demographics, clinical disease characteristics, and quality of life in a large cohort of psoriasis patients with and without psoriatic arthritis. Clin Cosmet Investig Dermatol 2015; 8: 563-9; https://doi.org/10.2147/CCID.S90270
  • Regional Council of Lombardy Region. Resolution X/6164 - 30/01/2017. “Governo della domanda: avvio della presa in carico di pazienti cronici e fragili. Determinazioni in attuazione dell’art. 9 della legge n. 23/2015”. Available at http://www.regione.lombardia.it/ (last accessed November 2018)
  • Regional Council of Lombardy Region. Resolution X/6551 - 04/05/2017. “Riordino della rete d’offerta e modalità di presa in carico dei pazienti cronici e/o fragili in attuazione dell’art.9 della legge regionale n.33/2009”. Available at Available at http://www.regione.lombardia.it/ (last accessed November 2018)

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