Initiating Patient Conversations for the Management of Plaque Psoriasis

Jayme Heim, MSN, FNP-BC: We’re going to look at how you practice and what that conversation looks like with that patient. A lot of times, especially new APPs [advanced practice providers], have a difficult time just setting down that flow. First of all, they must get used to all these different new medications and everything. They also must get used to that one-to-one interaction with that patient and having that conversation with that patient who has moderate to severe psoriasis. For you, what does that look like?

Matthew T. Reynolds, PA-C: That’s a great question. I think every patient is different, and certainly my approach to the plaque psoriasis patient has significantly evolved over time. For every patient who comes in, especially a new patient who is presenting with psoriasis that is of new onset or that’s been treated in the past by other providers, that first initial conversation with your plaque psoriasis patient is really essential for setting the foundation for not only the care that they will receive on that day of treatment, but for all subsequent dates of service moving forward in their care. I think it’s essential that we as the APP community are looking for ways to treat as many comorbid conditions in psoriasis that we know of when we can with 1 single molecule. I think if you can treat multiple conditions, say with a TNF therapy, for instance, your patients who do have other conditions that underlie the TNF pathway, I think it’s judicious for you to screen patients and try to identify them appropriately. I think it’s also very important that in those first initial conversations you establish a timeline of disease, and to start thinking about where is this patient going to be in 5 years or 10 years if we don’t treat with a systemic agent, and how aggressive is their psoriasis going to be in that time point. We all know that plaque psoriasis typically proceeds to psoriatic arthritis, and there is an 8-to-10-year window in those patients where they have a higher risk of developing psoriatic arthritis. It’s essential that not only at that first appointment that you’re screening them, asking them about signs and symptoms of psoriatic disease. You are palpating joints. You are asking them about morning stiffness, asking them about swollen digits or toes. I think you will be a much more well-rounded provider if you do that due diligence to your patients, and they’re going to be much better off if you do so. When I’m looking at classes of drugs, so in classes of drugs I mean specifically the TNFs, the IL-17s [interleukin-17], and the 23 class. When I’m looking at classes of drugs, I do allow my patients to help guide which treatment that they go on. I try to take their personal situation into context when I’m outlining treatment algorithms. Certainly, now currently when we have more oral options coming along, I think it’s very judicious to offer your patients an oral option. However, you do need to counsel them. For the most part, I think if you are getting a good history; you are screening them for severe complications, such as signs and symptoms or family history of inflammatory bowel disease; you’re screening them for psoriatic arthritis signs and symptoms at the onset of treatment, both at the onset of treatment and throughout the duration of treatment; you’re going to be treating the patient as a whole person and as a whole patient. I can’t stress that enough, just to look at many ways you can use your drugs, your armamentarium, to treat your patient wholly and completely.

Jayme Heim, MSN, FNP-BC: Another message that I’m hearing from you is that you’re not only the education piece of it, doing the assessment piece of it, but doing a shared decision-making between you and that patient and helping to guide that patient to the right therapy for their disease process with the plaque psoriasis. Is that correct?

Matthew T. Reynolds, PA-C: That’s correct, and I think that’s just essential. I’m sure Jayme, you practice very similarly. It’s very important to ask what the patient expects from their treatment and what they expect as far as how far they want to go with their skin. Some patients walk in and they’re 50% better and they’re about to do a backflip. They’re tickled over the moon. Other patients are expecting to be totally clear, 90% or better within 30 days or less. Every patient is different, but I do like to set expectations and I do like to ask where they want to go with their treatment. Then I help guide them to the right therapy.

Transcript edited for clarity