Poster 7
Title, Authors and Institutions: / Inflammatory skin disease eclipsed by skin cancer? Delays in access to hospital care for patients with chronic skin diseaseAlani A, Roche L, Lynch M, Sadlier M, Uddin A, Hackett C, Ahmad K, Ramsay B
Abstract:
(Your abstract must use Normal style and must fit in this space) / Nationally, amongst Hospital management boards, there exists an impetus to prioritise an increase in the proportion of new Dermatology patients reviewed, with a particular emphasis on achieving certain key performance indicators in skin cancer management. This drive can often be to the detriment of patients that require ongoing care for chronic inflammatory skin disease, delaying access to the hospital system and increasing both morbidity and eventual management costs.
In our service, the rates of triage of new referrals into ‘lesion assessment’ clinics, stands at 64% of total referrals in 2014 and 61% total referrals thus far in 2015. This allows only 36% (2014) and 39% (thus far in 2015) of outpatient appointment slots for assessment and management of new patients with inflammatory skin conditions.
We retrospectively assessed all patients currently on biologic therapy to determine how they accessed the hospital system and the time from initial presentation to treatment with systemic therapy/biologics, using our FileMakerPro vs12 database to extract the cohort. Our department database contains 36,555 letters from mid 2006 with 3096 letters solely for psoriasis patients. 114 patients are currently taking biologics – 94 patients with psoriasis, 13 with hidradenitis suppuritiva (HS), 5 with cutaneous crohns disease and 2 with behcets disease. Mean age was 48yrs (range 14-84yrs); 64F;50M. Although 55% were seen within 6 months of referral the mean wait from receipt of a gp referral letter to being seen in OPD was 11.6 months (range 0 – 87 months). The mean time for the patient arriving into hospital and transitioning from topical/phototherapy to systemic therapy – for example with fumarate - was 2.3 years (range 0-12yrs) and to transition to biologic therapy was 3.5 years (range 0-16yrs) from first assessment. 65% of patients are on maintenance therapy with the original biologic agent commenced, whereas 35% of patients are transitioning to different biologic agents to achieve disease control. The mean duration of therapy with etanercept was 3.7 years, 2.7 years for adalimumab (both with ranges of 0.5-9 years) and 2.2 years for ustekinumab (range 0-6 years). There were 41 patients on etanercept, 40 on adalimumab, 16 on ustekinumab, 14 on infliximab, 3 on golimumab. 106 systemic agents had been used prior to transition to biologic and 20 patients continued on combined systemic and biologic therapy to achieve control.
This study shows that patients with severe inflammatory skin disease face significant delays in accessing the hospital system. This is partly due to inadequate infrastructure and staffing of Dermatology units. It is vital to ensure hospital management understand the challenges posed by patients with severe inflammatory skin disease and the need for them to access dermatologic care in a timely manner.
Please return to closing date 26th August 2015