Editor – We read the article by Silver1 with great interest, and agree that as healthcare providers, we need to be involved in developing robust self-management strategies for our patients. In dermatology, we see patients with several chronic skin conditions, which often require years of secondary care follow-up. One such example is psoriasis, a common inflammatory skin condition, in which inadequate patient support and information can result in poor compliance and treatment failure. We have reviewed the literature of interventions designed to promote self-management in adults with psoriasis in order to better conceptualise self-management and to identify barriers. A total of 29 primary research articles were identified concerning self-management in psoriasis.
The literature reveals a broad view of self-management which focuses on patients tailoring treatment around their everyday lives. This applies across treatment modalities, from conventional topical therapies to home-based phototherapy.2 Whilst beneficial in theory, this autonomy may also pose significant challenges to patients in situations where their knowledge is limited, treatment is ineffective or psychosocial support is inadequate. This can lead to non-adherence, inappropriate self-medication and disengagement from healthcare appointments.
The evidence reinforces that the benefits of patient autonomy are optimised when care is individualised. To achieve this, physicians should provide guidance that enables patients to have an active role in decision making, whilst offering continuity of care. The perceived lack of knowledge among patients with psoriasis calls for targeted education. Given limited consultation times, the published evidence suggests that web-based technology3 and education delivered by allied healthcare professionals4 will be essential if patients are to develop self-management skills.
Six of the studies we reviewed included analysis of cost effectiveness, with three demonstrating a clear cost saving benefit for self-management for psoriasis, and three being equivocal. Going forward, randomised controlled trials with economic evaluation are required to rigorously test such educational interventions, as well as other self-management modalities. As we work towards better defined self-management interventions, we can anticipate improved treatment-adherence, better patient outcomes, less need for outpatient follow-up, and possible savings in our cash-strapped health service.
References
- 1.Silver I. Bridging the gap: person centred, place-based self-management support. Future Healthcare Journal 2018;5:188–91. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Edwards N, Imison C. How can dermatology services meet current and future patient needs, while ensuring quality of care is not compromised and access is equitable across the UK? The King's Fund, 2014. www.bad.org.uk/shared/get-file.ashx?id=2348&itemtype=document [Accessed 1 November 2018]. [Google Scholar]
- 3.Balato N, Megna M, Di Costanzo L, Balato A, Ayala F. Educational and motivational support service: A pilot study for mobile-phone-based interventions in patients with psoriasis. Br J Dermatol 2013;168:201–5. [DOI] [PubMed] [Google Scholar]
- 4.Ersser SJ, Cowdell FC, Nicholls PG, Latter SM, Healy E. A pilot randomized controlled trial to examine the feasibility and efficacy of an educational nursing intervention to improve self-management practices in patients with mild-moderate psoriasis. J Eur Acad Dermatol 2012;2:738–45. [DOI] [PubMed] [Google Scholar]