Study Evaluates Training Tool Developed for PCP Psoriasis Diagnosis

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Despite its prevalence and severity, psoriasis often goes underdiagnosed and undertreated. Recent studies indicate that delays in diagnosis can extend up to 5 years, particularly in primary care settings.¹ This situation is exacerbated in low- and middle-income countries, where psoriasis is frequently overlooked.²

A case-control study from the UK highlighted missed opportunities for early diagnosis, contributing to significant treatment delays.¹ The Global Psoriasis Atlas (GPA) corroborates these findings, indicating that many cases in community settings, especially in lower-resource environments, go unrecognized.² Given the limited number of dermatologists and the high demand for dermatological services, researchers behind a recent study recognized an urgent need to empower primary care practitioners with the skills necessary to diagnose psoriasis effectively.³

Task Shifting in Dermatology Care

To improve the diagnosis and management of skin conditions like psoriasis, task shifting has emerged as a viable strategy.⁴ Training community health workers, including general practitioners (GPs), nurses, and pharmacists, can enhance dermatological care in resource-limited settings. Initiatives like the Regional Dermatology Training Centre have successfully implemented community-oriented training programs in areas like Sub-Saharan Africa, demonstrating that enhanced education can improve healthcare outcomes.⁵

In response to the need for better diagnostic skills among non-dermatologists, a consensus-driven training tool for chronic plaque psoriasis has been developed in collaboration with the GPA and the International Psoriasis Council. This tool aims to improve the diagnostic capabilities of PCPs and was tested through a before-and-after study design.³

Methods

The study involved 60 participants from various professional backgrounds, including GPs, nurses, and pharmacists, recruited through the NIHR Clinical Research Network. The training consisted of 3 key components: a pre-training diagnostic assessment, a training session using medical illustrations, and a post-training assessment. Participants’ scores were analyzed to gauge improvements in diagnostic abilities, while a feedback survey assessed the training tool's effectiveness and user satisfaction.

Results

The study revealed significant improvements in diagnostic scores across all participant groups post-training. GPs showed the highest baseline scores, but nurses exhibited the most substantial increase in diagnostic ability following the training. Notably, participants reported increased confidence in their diagnostic skills, highlighting the training's effectiveness. Researchers said feedback indicated that the majority found the tool well-structured and useful, with suggestions for more detailed clinical scenarios.

These findings emphasized to researchers the importance of enhancing dermatological training for PCPs, particularly in settings with limited access to specialists. The use of medical illustrations in the training tool was found to be particularly beneficial, addressing the lack of diverse clinical images available for skin conditions. This innovative approach, likened by researchers to birdwatchers’ field guides, proves effective for teaching diagnostic skills across varied ethnic backgrounds. 

Implications for Practice and Future Research

Researchers behind these findings advocate for the integration of dermatology training into primary care, as early recognition of psoriasis is essential for timely treatment and management of associated comorbidities. They stated that establishing standardized diagnostic criteria is crucial for consistent epidemiological research and improving clinical outcomes.

The study suggested that future research should focus on validating the training tool in varied geographic and socioeconomic contexts to ensure its efficacy across different populations. The potential benefits of such training extend beyond improved diagnostic rates; researchers said they include reduced referral burdens on specialists and enhanced patient management within primary care settings.

Conclusion

Overall, researchers behind this tool feel that enhancing the diagnostic skills of primary care providers through targeted training can significantly improve the recognition and management of psoriasis. This initiation not only addresses current gaps in dermatological care but also has the potential to positively impact patient outcomes in diverse healthcare settings globally. As the healthcare landscape evolves, researchers said that continued investment in training and resources for PCPs will be crucial in managing chronic conditions like psoriasis effectively.

References

1. Abo-Tabik M, Parisi R, Morgan C, et al. Mapping opportunities for the earlier diagnosis of psoriasis in primarycare settings in the UK: results from two matched case-control studies. Br J Gen Pract. 2022;72(724):e834-e841. Published 2022 Oct 27. doi:10.3399/BJGP.2022.0137
2. Khan SS, Padovese V, Maurer TA, et al. A skin disease and needs assessment analysis of the displaced Rohingya population in the Kutupalong refugee camp, Bangladesh. Clin Exp Dermatol. 2020;45(8):1051-1054. doi:10.1111/ced.14310
3. Abo-Tabik M, Parisi R, Hann M, et al. Development and evaluation of an online training tool to aid in the diagnosis of chronic plaque psoriasis. JEADV Clin Pract. 2024; 1–7. https://doi.org/10.1002/jvc2.525
4. Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines. World Health Organization. Accessed October 11, 2024. https://apps.who.int/iris/bitstream/handle/10665/43821/9789241596312_eng.pdf
5. Annual report. UK: GPA. 2020-2021. GPA. Accessed October 11, 2024. https://www.globalpsoriasisatlas.org/uploads/attachments/cknrlwgij0hxiyojna6dk5cn2-gpa-annual-report-2020-2021-v2.pdf