Table 1.

Strengths and Needs in the Patient with Psoriasis and AD Journey

Phase	Strengths	Needs
Pre-diagnosis	–	Difficulty making an appointment at PC in the event of a flare (average of 5–6 days for an appointment) [patients]. “It was no possible to make an appointment at the health centre” Long waiting times in the ED [patients]. “We always have to wait a long time whenever we go to the emergency room” Lack of dermatological emergencies. Only the symptoms are treated [patients]. “Dermatological emergencies are a thing of the past. You go to the emergency room, they treat the symptoms (prick), and send you home” Lack of training, awareness, and empathy from some HCPs [patients]. “Some doctors just don’t have much empathy. They will tell you not to scratch, but that’s about it” Long waiting list and slow referral process [HCPs and patients]. “It took them a while to get me in to see the specialist”
Diagnosis	Good practice and experience in the Dermatology Service [patients]. “I had a great experience with the dermatologists. They’re all very professional” Quick diagnosis [patients]. “In my case, the diagnosis was pretty quick”	Insufficient coordination between PC and dermatology [HCPs and patients]. “It’s pretty clear that there’s room for improvement in the communication between primary care and dermatology” Misdiagnosis (years ago) [patients]. “This happened years ago, but I was initially diagnosed with something else, and it took some time to receive the correct diagnosis” Insufficient information received, including guidance on how to act in case of a flare [patients]. “I don’t know what to do about a flare”.
Treatment	Good practice from hospital pharmacy [patients]. “The hospital pharmacy was really helpful and professional” Wide experience managing complex patients. Participation in clinical trials [HCPs]. Patient counseling on treatment and support for administration [HCPs and patients]. “In the hospital pharmacy they explain everything very well and if necessary, they administer the treatment”.	Late access to effective treatments, especially in AD [patients]. “Why are there so many treatments that don’t work?” Scarce information on non-pharmacological aspects (ie, nutrition) [patients]. “Lack of information on eg which foods not to eat”. Scarce information on the treatment (ie, adverse events) [patients]. “After the treatment, I got herpes, but nobody told me about the possible side effects” Phototherapy is insufficient [patients]. “The phototherapy was helpful, but it wasn’t enough to get the disease under control” Lack of nurses specialised in chronic patients receiving immunomodulator treatments [HCPs]. Elevated waiting time due to the high number of patients attended [HCPs]. Lack of staff and insufficient space [HCPs].
Follow-up	Good communication between dermatology, nursing, and hospital pharmacy [patients]. Possibility of contacting dermatology by Email [patients with psoriasis]. “You can also contact the dermatologist by Email if you don’t want to wait for an in-person appointment”. Patient preferences taken into consideration [patients]. “They take my preferences into account as I try to lengthen my medication”. PROMs evaluated during follow-up visits [HCPs]. Pharmacotherapeutic adherence monitoring [HCPs]. Facilities for the patient to resolve spontaneous questions by Email [HCPs]. Ability to mediate between the patient and dermatology [HCPs].	Difficulty of contacting dermatology [patients with AD]. Follow-up visit after spaced treatment [patients]. PROMs not evaluated during follow-up visits (except for pruritus) [patients]. “They only ask about itching as a symptom” Long waiting list and low frequency of follow-up visits [patients]. “It’s been about three to four months since we started treatment, and we have not had a follow-up visit yet” Lack of telematic consultations [patients]. “It’s tough to get in touch with the dermatologist for follow-up questions” A clinical psychology service is available, but only accessible to severely affected patients [HCPs and patients]. “It’s pretty tough to get referred to psychological care” Lack of protocol for unscheduled visits in dermatology in the event of a flare [HCPs]. Lack of automatic programming of successive treatment dispensations [HCPs]. No referral from ED to dermatology [patients]. “If you go to the ED, then you have to make an appointment in dermatology, which will take a while. There is no possibility of referral from the ED”

Note: Brackets indicate participants who identified the strengths and needs in the care pathway.

Abbreviations: AD, atopic dermatitis; ED, Emergency Department; HCPs, healthcare professionals; PC, Primary Care; PROM, patient-reported outcomes measures.