JMIR Publications

ABSTRACT

Background:

Remote monitoring is increasingly used for psoriasis care, with the International Psoriasis Council (IPC) endorsing teledermatology (TD) as a feasible alternative to in-person visits. While evidence supports dermatologist-led (specialist) remote monitoring, there is limited research on its effectiveness in primary care. A publicly reimbursed remote monitoring program was piloted at both primary and specialist care levels, allowing comparative analysis of quality of life (QoL) outcomes and insights into factors contributing to better management outcomes.

Objective:

The aim of study was to evaluate the feasibility and effectiveness of remote psoriasis monitoring at both primary and specialist care levels, identifying factors that influence better outcomes at the primary care level.

Methods:

Study employed a retrospective convergent parallel mixed-methods approach to analyze data from 110 patients initially recruited into a publicly reimbursed remote monitoring program between January 2022 and July 2023 at 7 family medicine centers and 1 outpatient dermatovenerology center. The study utilized data from a public insurance claims database and a TD platform, which included reports on the Dermatology Life Quality Index (DLQI) and additional metrics. The effectiveness of remote monitoring at both care levels was assessed via baseline-to-average DLQI comparisons. The minimal clinically important difference (MCID) was set at ≤ -3, and odds ratios (OR) between care levels were calculated, with specific cases analyzed via case series. Additionally, correlation analysis examined associations between DLQI changes and variables such as baseline Psoriasis Area Severity Index (PASI) scores, patient demographics, and collaborative care tools like e-consultation.

Results:

The specialist care group (n=39) showed a significant mean reduction in DLQI of -1.33 (p = .011), whereas the primary care group (n=37) demonstrated a non-significant change of -0.34 (p = .359). Patients receiving specialist care were 3.91 times more likely to achieve a clinically significant improvement (MCID ≤ -3) compared to those in primary care (p = .042). Collaborative care between Primary Care Practitioners (PCPs) and specialists was linked to more favorable changes in DLQI scores (r = -.339, p = .040) at the primary care level. Case series analysis of patients achieving MCID in primary care revealed variability in management approaches, including PCP-led models incorporating collaborative care elements and nurse-led models without such collaboration.

Conclusions:

This study is the first to compare remote psoriasis monitoring across specialist and primary care levels. While effective in specialist care, remote management at primary care shows less significant patient outcome improvements, mirroring findings from in-person PCP-led care. Using public claims data, the study highlights that integrating specialist support into PCP-led care through standardized e-consultation may enhance outcomes. It underscores the need for further research and standardized collaborative care models between primary care providers and specialists in psoriasis remote management. Clinical Trial: The study received approval from the Research Ethics Committee of the University of Tartu, Estonia (ethical approval code: 350/T-14)