Management of a Chronic Skin Disease in Primary Care: An Analysis of Early-Career General Practitioners' Consultations Involving Psoriasis

Sameerah Nawaz; Amanda Tapley; Andrew R Davey; Mieke L van Driel; Alison Fielding; Elizabeth G Holliday; Jean Ball; Irena Patsan; Alyse Berrigan; Simon Morgan; Neil A Spike; Kristen FitzGerald; Parker Magin

doi:10.5826/dpc.1103a55

Management of a Chronic Skin Disease in Primary Care: An Analysis of Early-Career General Practitioners' Consultations Involving Psoriasis

Dermatol Pract Concept. 2021 May 20;11(3):e2021055. doi: 10.5826/dpc.1103a55. eCollection 2021 May.

Authors

Sameerah Nawaz¹, Amanda Tapley^{2

3}, Andrew R Davey^{2

3}, Mieke L van Driel⁴, Alison Fielding^{2

3}, Elizabeth G Holliday², Jean Ball⁵, Irena Patsan^{2

3}, Alyse Berrigan³, Simon Morgan¹, Neil A Spike^{6

7}, Kristen FitzGerald^{8

9}, Parker Magin^{2

3}

Affiliations

¹ GP Synergy, Regional Training Organisation, Liverpool, NSW, Australia.
² The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.
³ GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, NSW, Australia.
⁴ The University of Queensland Faculty of Medicine, Primary Care Clinical Unit, Brisbane, QLD, Australia.
⁵ Hunter Medical Research Institute, Clinical Research Design, IT and Statistical Support Unit (CReDITSS), New Lambton, NSW, Australia.
⁶ Eastern Victoria GP Training, General Practice Training Organisation, Melbourne, Australia.
⁷ The University of Melbourne, Department of General Practice, Melbourne, VIC, Australia.
⁸ University of Tasmania, School of Medicine, Hobart, TAS, Australia.
⁹ General Practice Training Tasmania (GPTT), Regional Training Organisation, Hobart, TAS, Australia.

Abstract

Background: The management of psoriasis by general practitioners (GPs) is vital, given its prevalence, chronicity, and associated physical and psychosocial co-morbidities. However, there is little information on how GPs (including early-career GPs) manage psoriasis.

Objectives: This study assessed the frequency with which Australian specialist GP vocational trainees ('registrars') provide psoriasis care and the associations of that clinical experience.

Methods: A cross-sectional analysis was done of data from the ReCEnT study, an ongoing multi-site cohort study of Australian GP registrars' experiences during vocational training. In ReCEnT, 60 consecutive consultations are recorded 3 times (6-monthly) during each registrar's training. The outcome factor for this analysis was a problem/diagnosis being psoriasis, and independent variables were related to registrar, patient, practice and consultation factors. This study analysed 17 rounds of data collection (2010-2017) using univariate and multivariable regression.

Results: Data from 1,741 registrars regarding 241,888 consultations and 377,980 problems/diagnoses were analysed. Psoriasis comprised 0.15% (n=550) of all problems/diagnoses (95% CI, 0.13-0.16). Significant patient multivariable associations of a problem/diagnosis being psoriasis included age, gender, being new to a practice or a registrar, and psoriasis being an existing problem rather than a new diagnosis. Significant registrar associations included seeking in-consultation information/assistance, not scheduling a follow-up appointment, prescribing medication, and generating learning goals.

Conclusions: Australian registrars have modest training exposure to psoriasis and may find psoriasis management challenging. Furthermore, continuity of care (essential for optimal chronic disease management) was modest. The findings have implications for GPs' approaches to the management of psoriasis more widely as well for general practice education and training policies.

Keywords: chronic disease; continuity of patient care; family practice; general practice; medical and graduate education; psoriasis.