“Patients with psoriasis are at an increased risk for cardiovascular disease and die several years younger than patients without psoriasis, even after controlling for other traditional risk factors such as smoking, diabetes, high blood pressure, and high cholesterol,” explains John S. Barbieri, MD, MBA. “Therefore, managing and preventing cardiovascular disease among patients with psoriasis is incredibly important. However, we have found that among patients with psoriasis, only about 20% have an active relationship with a primary care provider, so it’s important for us as physicians—particularly dermatologists and rheumatologists—to think about how we can prevent cardiovascular disease among this patient population.”
For a research letter published in the Journal of the American Academy of Dermatology, Dr. Barbieri and colleagues aimed to study how often counseling patients about common risk factors for psoriasis and psoriatic arthritis (PsA) was being conducted in routine practice. Using the nationally representative National Ambulatory Medical Care Survey (NAMCS, 2002-2016)) and the National Hospital Ambulatory Medical Care Survey (NHAMCS, 2002-2011), they examined the rate of education/counseling during patient visits for psoriasis/PsA for several modifiable risk factors, including tobacco use, obesity, and diet and exercise.
Preventative Counseling Uncommon
There were an estimated 41.8 million visits for psoriasis/PSA in the study period (50.5% male), with most patients of White, non-Hispanic race/ethnicity (81.2%), with a mean age of 52. For all analyses, rates of visits to dermatologists versus non-dermatologists were compared with Chi-squared tests and multivariable logistic regression, adjusting for socioeconomic confounders.
“Our study team found that this counseling for modifiable risk factors is uncommon, both at visits to dermatologists and non-dermatologists,” Dr. Barbieri says. “For example, among patients who are current or former smokers (35.7%), only 7% of non-dermatologists and 1% of dermatologists counseled them about smoking cessation at visits for psoriasis/PsA. Among all patient visits for psoriasis/PsA, modifiable risk factors such as smoking, obesity, and diet and exercise were discussed at only 23% of visits with a non-dermatologist and 1% of visits with a dermatologist. Obesity counseling rates at psoriasis/PsA visits were approximately 2.8% and were also less frequent at visits to dermatologists (Table).” Counseling about any modifiable lifestyle risk factor took place at 11.1% of all visits, he adds, and was markedly less common at visits to dermatologists (0.9% vs 22.6%). In addition, counseling/education for tobacco use was significantly less common at visits with Hispanic patients as compared with White, non-Hispanic patients.
Dermatologists & Rheumatologists Main Points of Care“While we realize that these numbers might be an underestimate, based on some of the limitations of this dataset, it certainly highlights a need for us to improve the counseling we provide for patients with psoriasis/PsA,” Dr. Barbieri notes. “Based on these findings, we believe that several types of interventions are possible. First, we need better education, both among patients and clinicians, about the risk for cardiovascular disease among patients with psoriasis/PsA. In addition, for many patients, dermatologists and rheumatologist are often the main points of care. Some patients may not have a primary care provider at all or may not visit that clinician regularly, so this presents an opportunity for dermatologists and rheumatologists to become more involved in this type of counseling.”
Dr. Barbieri and colleagues would like to see future research address some of the limitations in this study. “Since this is a cross-sectional dataset, it doesn’t look at patients over time, so there may be those who get counseled at one visit but not at a different visit, and we did not capture that,” he says. “Most importantly, we need to think about how best to prevent cardiovascular disease in this population. One of the ways we can accomplish this is to use collaborative care models, where we engage dermatologists, rheumatologists, and other clinicians like cardiologists and primary care providers, to work as a team to optimize cardiovascular risk prevention among patients with psoriasis/PsA.”
Visit physweekly.com/podcast for the full interview with John S. Barbieri, MD, MBA!