Paradigm Shifts in the Management of Plaque Psoriasis: Advanced Practice Provider Perspectives - Episode 1

Impact of Psoriasis on a Patients’ Overall Well-Being

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The clinical and psychological impact of plaque psoriasis on a patient’s overall well-being.


Matthew Brunner, MHS, PA-C, DFAAPA: Welcome to this HCPLive® Peers & Perspectives® presentation titled, “Paradigm Shifts in the Management of Plaque Psoriasis—Advanced Practice Provider Perspectives.” I’m Matthew Bruner, physician assistant at the Dermatology & Skin Surgery Center in Stockbridge, Georgia. I am joined today by my friend and colleague Lakshi Aldredge, nurse practitioner of the dermatology service of the VA Portland Health Care System in Portland, Oregon. Our discussion focuses on the role of nurse practitioners [NPs] and physician assistants [PAs] in patient care and improving outcomes of plaque psoriasis. We will also discuss the safety and efficacy of available treatments. Welcome, Lakshi, let’s begin.

Lakshi Aldredge, MSN, ANP-BC, DCNP: Hi, Matt. I’m delighted to be here with you, and I’m excited to have this conversation.

Matthew Brunner, MHS, PA-C, DFAAPA: Lakshi, when you think about your patients, and how plaque psoriasis impacts their lives, can you tell me how you think it impacts them in their physical lives, as well as mentally and in their social lives?

Lakshi Aldredge, MSN, ANP-BC, DCNP: Absolutely, Matt. You and I have taken care of psoriasis patients for many years, and the real joy in taking care of patients with psoriasis is because this is a long-term relationship you develop with them. Because as you know, we don’t have a cure for psoriasis. Psoriasis is an autoimmune-mediated disease, much like diabetes and some thyroid diseases. These patients suffer when they know that they have a condition that is very visible on their skin that everyone sees. And they’ve been told there’s no cure for it. It is a disease that warrants NPs and PAs and any providers to look at patients holistically, and that means not only looking at their clinical and physical manifestations of their disease, but also the psychosocial aspect of the disease. These patients have myriad comorbidities also that can go along with their psoriasis. Patients with more moderate to severe psoriasis can be at risk for developing type 2 diabetes, cardiovascular disease, liver disease, even Crohn disease. Given all the impacts that psoriatic disease can play on a patient’s physical well-being, but also on their mental health, knowing that they have a chronic disease, that they could have developed these more significant comorbidities, it becomes part and parcel of caring for the whole patient, when NPs and PAs take care of these patients. I like to start by telling patients that I’m going to be with them throughout their journey of psoriasis and psoriatic disease, and that I plan to work with them with the goal of getting them as clear as possible, and also helping them to control those other comorbidities. And you know, Matt, I’m sure that you have seen many psoriasis patients. One of the biggest challenges is trying to understand how we, first of all, describe psoriasis and how to determine how severe the disease is. When you look at your patients, how do you start that conversation about assessing the severity of their psoriasis?

Matthew Brunner, MHS, PA-C, DFAAPA: For me, that conversation starts from a sitting position. That’s one of the most important things as a practitioner, to come into the room, sit down with the patient and meet with them eye to eye to talk to them about where they’ve been, what they’re going through, what kind of previous treatments they’ve had, how they view it impacting their lives, because patients are individualistic. Especially when you think about the psychosocial impact, the higher rates of depression and suicidality in these patients, you need to approach your patient with an understanding of where they’re coming from, and what their treatment goals are. Then I like to do an examination. Sometimes patients have a preconceived notion of their diagnosis before they arrive. Many of them I find have less education about their condition. They don’t understand the comorbidities, and that’s an important discussion to have with the patients, both on day 1 of the visit when you meet them, but also on those subsequent visits as reminders to make sure they’re having their regular screenings with their primary care provider, as well as making sure that you’re reaching their treatment goals. Sometimes as providers, we have our own preconceived notions of treatment goals.

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Transcript edited for clarity.