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      Management of a Chronic Skin Disease in Primary Care: An Analysis of Early-Career General Practitioners’ Consultations Involving Psoriasis


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          The management of psoriasis by general practitioners (GPs) is vital, given its prevalence, chronicity, and associated physical and psychosocial co-morbidities. However, there is little information on how GPs (including early-career GPs) manage psoriasis.


          This study assessed the frequency with which Australian specialist GP vocational trainees (‘registrars’) provide psoriasis care and the associations of that clinical experience.


          A cross-sectional analysis was done of data from the ReCEnT study, an ongoing multi-site cohort study of Australian GP registrars’ experiences during vocational training. In ReCEnT, 60 consecutive consultations are recorded 3 times (6-monthly) during each registrar’s training. The outcome factor for this analysis was a problem/diagnosis being psoriasis, and independent variables were related to registrar, patient, practice and consultation factors. This study analysed 17 rounds of data collection (2010–2017) using univariate and multivariable regression.


          Data from 1,741 registrars regarding 241,888 consultations and 377,980 problems/diagnoses were analysed. Psoriasis comprised 0.15% (n=550) of all problems/diagnoses (95% CI, 0.13–0.16). Significant patient multivariable associations of a problem/diagnosis being psoriasis included age, gender, being new to a practice or a registrar, and psoriasis being an existing problem rather than a new diagnosis. Significant registrar associations included seeking in-consultation information/assistance, not scheduling a follow-up appointment, prescribing medication, and generating learning goals.


          Australian registrars have modest training exposure to psoriasis and may find psoriasis management challenging. Furthermore, continuity of care (essential for optimal chronic disease management) was modest. The findings have implications for GPs’ approaches to the management of psoriasis more widely as well for general practice education and training policies.

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          Most cited references35

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          Psoriasis is an immune-mediated, genetic disease manifesting in the skin or joints or both. A diverse team of clinicians with a range of expertise is often needed to treat the disease. Psoriasis provides many challenges including high prevalence, chronicity, disfiguration, disability, and associated comorbidity. Understanding the role of immune function in psoriasis and the interplay between the innate and adaptive immune system has helped to manage this complex disease, which affects patients far beyond the skin. In this Seminar, we highlight the clinical diversity of psoriasis and associated comorbid diseases. We describe recent developments in psoriasis epidemiology, pathogenesis, and genetics to better understand present trends in psoriasis management. Our key objective is to raise awareness of the complexity of this multifaceted disease, the potential of state-of-the-art therapeutic approaches, and the need for early diagnosis and comprehensive management of patients with psoriasis.
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            Global epidemiology of psoriasis: a systematic review of incidence and prevalence.

            The worldwide incidence and prevalence of psoriasis is poorly understood. To better understand this, we performed a systematic review of published population-based studies on the incidence and prevalence of psoriasis. Three electronic databases were searched from their inception dates to July 2011. A total of 385 papers were critically appraised; 53 studies reported on the prevalence and incidence of psoriasis in the general population. The prevalence in children ranged from 0% (Taiwan) to 2.1% (Italy), and in adults it varied from 0.91% (United States) to 8.5% (Norway). In children, the incidence estimate reported (United States) was 40.8/100,000 person-years. In adults, it varied from 78.9/100,000 person-years (United States) to 230/100,000 person-years (Italy). The data indicated that the occurrence of psoriasis varied according to age and geographic region, being more frequent in countries more distant from the equator. Prevalence estimates also varied in relation to demographic characteristics in that studies confined to adults reported higher estimates of psoriasis compared with those involving all age groups. Studies on the prevalence and incidence of psoriasis have contributed to a better understanding of the burden of the disease. However, further research is required to fill existing gaps in understanding the epidemiology of psoriasis and trends in incidence over time.
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              New England Journal of Medicine, 361(5), 496-509

                Author and article information

                Dermatol Pract Concept
                Dermatol Pract Concept
                Dermatology Practical & Conceptual
                Mattioli 1885
                July 2021
                20 May 2021
                : 11
                : 3
                : e2021055
                [1 ]GP Synergy, Regional Training Organisation, Liverpool, NSW, Australia
                [2 ]The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia
                [3 ]GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, Mayfield West, NSW, Australia
                [4 ]The University of Queensland Faculty of Medicine, Primary Care Clinical Unit, Brisbane, QLD, Australia
                [5 ]Hunter Medical Research Institute, Clinical Research Design, IT and Statistical Support Unit (CReDITSS), New Lambton, NSW, Australia
                [6 ]Eastern Victoria GP Training, General Practice Training Organisation, Melbourne, Australia
                [7 ]The University of Melbourne, Department of General Practice, Melbourne, VIC, Australia
                [8 ]University of Tasmania, School of Medicine, Hobart, TAS, Australia
                [9 ]General Practice Training Tasmania (GPTT), Regional Training Organisation, Hobart, TAS, Australia
                Author notes
                Corresponding author: Parker Magin, PhD, FRACGP, 20 McIntosh Dr, Mayfield West, 2304 NSW, Australia. Email: parker.magin@ 123456newcastle.edu.au
                ©2021 Nawaz et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original authors and source are credited.

                : 14 December 2020

                general practice,family practice,psoriasis,continuity of patient care,medical and graduate education,chronic disease


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