Online Tool Developed to Improve Diagnostic Skills of Non-Dermatologists for Psoriasis

A newly-created online diagnostic tool is effective in improving the abilities of primary care practitioners and non-dermatologists to diagnose chronic plaque psoriasis, new findings suggest.¹

This research was led by Maha Abo-Tabik, from the division of musculoskeletal & dermatological sciences, at the University of Manchester’s NIHR Manchester Biomedical Research Centre. The investigators noted that a consensus-agreed diagnostic criteria list for chronic plaque psoriasis had been made to improve early diagnoses of the condition by non-dermatologists.²

“The aim of this study was to develop and evaluate a new training tool designed to improve the diagnostic skills of nondermatologists for (chronic plaque psoriasis) and to compare the diagnostic ability of participants before and after training,” Abo-Tabik and colleagues wrote.¹

Background and Design

The investigators’ online training tool was designed with the aim of improving the diagnosis of psoriasis for non-dermatologists, basing it on the results of their earlier international e-Delphi study to develop clinical diagnostic criteria for chronic plaque psoriasis among adults. They also carried out a before-and-after exploratory investigation of the training tool in the period between December 2021 - March 2022.

The research team’s analysis involved a total of 60 subjects, with 20 participants per professional group. The subjects had been recruited through the use of the NIHR Clinical Research Network, with the 20-member cohorts including nurses, general practitioners (GPs), and pharmacists from English general practices.

The training tool was hosted by a specifically-designed website, with the investigators including a short demographic data questionnaire, a training package, and a structured survey to assess feedback. There were 3 steps used in the training section: a pre-training assessment looking into users’ baseline skills in the diagnosis of the skin disease; a training session implementing medical illustrations; and a test for post-training in which pre-training scenarios were repeated to evaluate the gain of knowledge.

For the purposes of looking at user views on the tool’s content, design, and utility, the research team provided a feedback questionnaire. They determined their main outcome measure to be the shift in the median diagnostic score between tests in the pre- and post-training section (i.e., ability of those involved in the study to identify or rule out a diagnosis of psoriasis following the training).

Their online questionnaires were evaluated, with the team summarizing through descriptive statistics and using medians and interquartile ranges for continuous variables and frequencies with percentages for categorical variables. Shifts in subjects’ test scores prior to and following the training were compared overall and by profession through the use of summary statistics and linear regression, adjusting for years of participants’ clinical experience.

Conclusions

Overall, among the 60 participants who completed the study, it was reported that the online training tool improved the diagnostic skill levels of participants for chronic plaque psoriasis. On average, the skills of GPs were notably higher than those of nurses and pharmacists prior to and following the training.

The investigators noted that participants found the training invaluable and relevant to diagnosis in primary care settings, with 95% reporting the tool to be well-structured and easy to follow. Additionally, 88% reported meeting learning objectives for 88% and 80% reported written material as suitable.

The research team also found that 85% viewed the visuals as a helpful element. However, the team also reported that 15% desired more clinical scenario detail. Nevertheless, 85% were shown to have agreed the tool could serve as future reference.

“Findings from our recent population-based case control study using primary care data suggested that potential missed opportunities for earlier diagnosis of psoriasis can be identified from primary care records,” they wrote. “Such opportunities may contribute up to 5 years' delay in establishing treatment, and monitoring for co-morbidities for some individuals.”^1,3

References

1. ^{Abo-Tabik M, Parisi R, Hann M, Tucker R, Willis S, Ashcroft DM, 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.}
2. ^{Abo-Tabik M, Parisi R, Willis SC, Griffiths CEM, Ashcroft DM. Development of clinical diagnostic criteria for chronic plaque psoriasis: an international e-Delphi study. Br J Dermatol. 2021; 185(2): 455–456.}
3. ^{Abo-Tabik M, Parisi R, Morgan C, Willis S, Griffiths CE, Ashcroft DM. Mapping opportunities for the earlier diagnosis of psoriasis in primary care settings in the UK: results from two matched case–control studies. Br J Gen Pract. 2022; 72(724): e834–e841.}