The Development of a Rapid Access Clinic for patients with Psoriasis (P-RAC)
The Psoriasis Rapid Access Clinic (P-RAC) opened in January 2019 and is led by Professor Chris Griffiths, Director of the Manchester Centre for Dermatology Research and Dermatology Theme Lead for the Manchester BRC. The Salford-based clinic is an innovative, community-based and consultant-led clinic, which provides integrated management to newly-diagnosed psoriasis patients who receive very early access to specialist and personalised care within weeks of diagnosis. It is a unique collaboration between NIHR Manchester BRC, the NHS Salford Clinical Commissioning Group (CCG) Innovation and Research Oversight Group and The University of Manchester under the umbrella of the Greater Manchester Health and Social Care Partnership (GMHSCP) and Health Innovation Manchester.
Early disease is a key time for intervention from a patient perspective, preventative model and population health point of view – and our research has demonstrated a positive shift in patients’ understanding and sense of control over their health. What is particularly innovative about this clinic is that people with psoriasis are rapidly referred by GPs to expert care early in the disease cycle; something that hasn’t been done for psoriasis previously and has the potential to revolutionise care of this common disease.
P-RAC has its roots in the NIHR-funded Identification and Management of Psoriasis Associated ComorbidiTy (IMPACT) programme which investigated the other diseases that people with psoriasis often suffer with (known as co-morbidities), the coping strategies used by patients, and the barriers encountered by healthcare professionals to providing behaviour change advice to patients.
Most patients develop psoriasis before the age of 35 and, with time, they can accumulate physical, psychological and socioeconomic morbidity as a consequence. Using NHS datasets and in-depth research, IMPACT found that unhealthy lifestyle behaviours are increased among people with psoriasis including smoking, excess alcohol consumption and increased body mass index (BMI), while many faced a long wait for specialist assessment and disengagement from health services.
The PsoWell® training programme for healthcare professionals, co-developed with patients, was a product of the IMPACT programme and aimed to enable a patient-centred focus that facilitates health behaviour change and improves care and outcomes. It provided personally relevant materials to psoriasis patients that enabled them to live well and reduce likelihood of acquired comorbidities.
The P-RAC clinic is highly proactive with respect to these comorbidities and screen for depression and anxiety, psoriatic arthritis and risk factors for cardiovascular disease. All patients receive psychoeducational resources, including information about lifestyle factors which can increase the risk of flare ups, practical advice about topical therapies and details of available treatments.
Patients are reviewed by a health psychologist, who can signpost patients to additional hospital or community support as necessary, including community-based social prescribing services. Those with moderate-severe psoriasis are identified and fast-tracked to hospital services for early intervention with systemic therapy. Those suitable for topical monotherapy are discharged to their GP at the end of the intervention, with a clear management plan and links to the local psoriasis management pathway are highlighted to facilitate GP education.
Results to date demonstrate that patients attending this clinic have significant comorbidities, which need to be addressed. Patients reported an improved understanding of their psoriasis, the treatment prescribed, and sense of control over their condition. They were also more motivated to learn more about psoriasis and make healthy lifestyle choices.
A variety of patient and physician reported outcome measures were improved upon within four weeks of attending this clinic. These results have been accepted for presentation at the British Association of Dermatologists annual meeting and the European Academy of Dermatology and Venerology annual meeting.
This has significant health and social care economic benefits – including reducing work absence and attaining appropriate education. Another important innovation is that this group of patients – early in their disease course – are unique to dermatology research centres and provide an important opportunity for prospective studies on how the immunology and epigenetics of the disease may change with time. The team are currently profiling these patients by collecting biological samples for future genomic and proteomic research.