Role of Multidisciplinary Team Management for Patients With Plaque Psoriasis

Alexa Hetzel,MS, PA-C: So, Jayme, how do you incorporate, in your practice, the use of multidisciplinary specialists when treating psoriasis patients?

Jayme M. Heim, MSN, FNP-BC: I think it’s really important to have a multidisciplinary approach. For one thing, I think that all patients should have a primary care physician. We know that those patients with psoriasis have an increased risk of comorbidities just because they have psoriasis. They have an increased risk of diabetes, heart disease, stroke, as well as obesity and fatty liver disease. We need to make sure that their family care providers are a part of that cure when we’re working with that patient. Sometimes, we have patients on medications that may affect their triglycerides, and we may need to have a comanagement with that. Other times, they don’t understand why a patient’s liver enzymes are increased, and yet, they have fatty liver disease. Or other times, when we are working with the patient and we’re drawing baselines labs, and we’re the first one to find out that they have type II diabetes. I want to know who that primary doctor is and I want to have those labs sent over to them so that patient can be managed appropriately. So, I think that that’s a step that’s very important.

We also know, as Douglas DiRuggiero just mentioned, that patients not only have cutaneous disease, but they also have disease within their joints. Even though it’s a smaller percentage, those patients, they do have psoriatic arthritis. And so, for those patients, as dermatologists or dermatology providers, we need to address that. We need to evaluate for that every time that we do a physical assessment on a patient. In my area in Michigan, it’s very difficult to get patients into rheumatology. Fortunately enough, I’ve been specializing in what I do for almost 2 decades, so I treat psoriasis and psoriatic arthritis. A lot of our medications are for psoriasis and psoriatic arthritis, and a lot of times, if you treat them appropriately, their joints follow right along with the resolution of their skin disease. They have improvement. However, sometimes, there are patients that we have that don’t respond the way that we’d hope that they would respond. Those patients I always refer over to rheumatology, even though there’s a longer wait, just to be able to have that collaboration with rheumatology. A lot of times there’s very little change that is done, but the patient has the reassurance and I also have the reassurance that the patient’s treated correctly. The other way that there’s collaborations done is with their comorbid conditions. Patients that may come to us with a previous history of cancer, hepatitis, or heart disease, and they have moderate to severe psoriasis that needs to be treated, or they have psoriatic arthritis along with their moderate to severe psoriasis and that is another way that I collaborate with the specialists in putting a patient on medication. So, I think those are really important factors.

The last factor that I’d like to mention is the team, and it’s really important to have a team approach when you’re treating a patient. So, my nurses understand the needs for patients with psoriasis. We talk about it, we discuss, they know what tests to give and why. They have a lot of empathy for patients with psoriasis, and they have a lot of passion for treating those patients. We also have a biologic coordinator. So it’s more or less a team approach. There’s a lot of collaboration that really goes on so that that journey for that patient with psoriasis and psoriatic arthritis is a successful journey.

Alexa Hetzel,MS, PA-C: I love that. It’s like the 12th man in football, right? It’s always good to have a team.

Jayme M. Heim, MSN, FNP-BC: It is.

Alexa Hetzel,MS, PA-C: Because we can only succeed in how strong we are with everybody surrounding us.

Transcript edited for clarity