Two academics at Robert Gordon University have been involved in the creation of a groundbreaking national guideline for improved care of patients with psoriasis and psoriatic arthritis. For one of the academics, this dovetails with a personal effort to improve healthcare provision for the condition which has affected her mother for 58 years.
Published last week (Friday 29 October), the authors of the Scottish Intercollegiate Guidelines Network (SIGN) guideline believe that it is the "missing link" that will bring about improved diagnosis and treatment by GPs in primary care.
The guideline from the SIGN, part of NHS Quality Improvement Scotland (NHS QIS), was published on World Psoriasis Day and is the first of its kind internationally to draw together the best available evidence on diagnosing and treating psoriasis and psoriatic arthritis, recognising the need to see the relationship between both conditions and to treat them in a co-ordinated fashion.
Key recommendations contained within the guideline include:
Patients should have an annual review with their GP
Patients should have access to appropriate multidisciplinary care
Assessment of patients should include psychosocial measures, with referral to psychological services as appropriate
Active involvement of patients in managing their care should be encouraged.
Drs Lorna McHattie and Derek Stewart from the University's School of Pharmacy and Life Sciences have been involved in the guideline since its formative period. In particular, Dr Stewart lent the network his expertise on pharmaceutical aspects of treatment, and Dr McHattie considered how people with psoriasis are most effectively cared for through the healthcare system. This included a focus on patient-GP interaction, referral to hospital, patient interaction with non-medical staff (such as specialist nurses) and medication regimes.
"The SIGN guideline is of particular interest to me", explained Dr McHattie, "as I have several close family members who have suffered from psoriasis and have often received less than optimal treatment. I am therefore glad to able to play a part in improving the treatment for people who have this condition."
Her mother, Margaret Walters (75) from Abergeldie Road, is a long-time sufferer of psoriasis which first expressed itself in her late teens. Her broad experience of the treatment for her condition over the last 58 years has consisted of being prescribed a series of topical treatments that have been available to her on an ongoing repeat-prescription basis, with little consideration to long term treatment plans.
Having been made aware by her daughter of the changes proposed in the SIGN guidelines, Mrs Walters said: "One thing that particularly interested me is the annual review with your GP that is proposed. I feel this would be a marked improvement to the current system where you can go years without reviewing your condition.
"It would be really beneficial to sufferers like me to receive this increased attention as I feel it would further cultivate an appreciation among the medical community that, although not terminal, this condition can be painful, embarrassing and hugely debilitating."
Dr McHattie (53), from Louisville Avenue, is currently in the finishing stages of a study which was funded by Pfizer UK - one of the world's leading pharmaceutical companies - which investigates peoples' perception of their psoriasis care.
She will be attending meetings in The Scottish Parliament this month and in December to discuss the guideline and her own research with a cross party group of MSPs who consider the care of people with chronic conditions.
The first meeting has been convened by PSALV (Psoriasis Scotland Arthritis Link Volunteers) and their Chairperson Janice Johnson who has been a driving force in seeking more effective care for people with psoriatic arthritis.
Concerning the guideline's publication, Janice Johnson said: "This is excellent news for all people with skin psoriasis and the associated inflammatory arthritis. We are delighted that psoriasis and psoriatic arthritis are addressed in the same guideline. Having lobbied hard for this new information, and worked with the guideline development group, we hope that all those responsible for the care of sufferers take note of this publication and its recommendations. GPs need more knowledge to be able to diagnose and refer people to specialists at an early stage, and this guide will give them the best information to make the right decisions."
Dr David Burden, Consultant Dermatologist at Glasgow's Western Infirmary and chair of the guideline development group, said: "This guideline can be the missing link for GPs to improve their knowledge of psoriasis and psoriatic arthritis, and to improve the care that these patients receive. Improved knowledge and co-ordinated treatment are key to managing a condition that can have a significant effect on people's quality of life."
Stewart Campbell, a Scotland Trustee of the Psoriasis Association, said: "The Association was very pleased to be involved in the development of the guideline. From a patient perspective, the evidence-based approach of the guideline is vital, and the clear recommendations given about treatment options should be a great help to patients and health professionals. In addition, the coverage of psoriasis and psoriatic arthritis in the same guideline, and the recommendations on an integrated approach to care should, if adopted throughout Scotland, make a real difference to the lives of patients with both conditions."
Notes for Editors:
SIGN (Scottish Intercollegiate Guidelines Network) develops national clinical guidelines aimed at reducing variations in clinical practice and in outcomes for patients. Founded in 1993, SIGN became part of the national clinical effectiveness body, NHS Quality Improvement Scotland, on 1 January 2005.
The 2010 guideline includes information on the following areas:
- Diagnosis, assessment and monitoring
- Treatment in primary care (GPs)
- Treatment in secondary care (hospital setting)
- Pharmacological and biological therapy
- Patient information
- A care pathway between primary and secondary care.
The SIGN guideline is available from www.sign.ac.uk
NHS QIS is a Special Health Board that provides support to NHS Scotland. We translate the latest scientific research, expert opinion and patient experience to help improve the quality of healthcare in Scotland. Key components of our organisation are: The Healthcare Environment Inspectorate, Scottish Health Council, and the Scottish Intercollegiate Guidelines network (SIGN). We also take a lead role in co-ordinating the work of the Scottish Patient Safety Programme and provide support to the Scottish Medicines Consortium.
Psoriasis is a common chronic inflammatory disease that affects the skin and joints. Over 100,000 people in Scotland are affected - 20,000 of whom are likely to have psoriatic arthritis also. In extreme cases, the impact on quality of life is the equivalent to heart disease, diabetes, depression and cancer.
- Dr Lorna McHattie worked for many years in Training and Development provision within the Volunteer Social Care sector. She returned to academia in her 40s, seeking a change of career. She undertook a PHD in Public Health at Aberdeen University, graduating in 2005. She joined the University in 2006 as a lecturer within the School of Pharmacy and Life Sciences.
Robert Gordon University
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