Nelson, PA and Barker, Z and Griffiths, CEM and Cordingley, L and Chew-Graham, CA (2013) 'On the surface': a qualitative study of GPs' and patients' perspectives on psoriasis. BMC Family Practice, 14. 158 -?. ISSN 1471-2296

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Abstract

BACKGROUND: Psoriasis is a chronic, inflammatory skin disease affecting approximately 2% of the UK population and is currently incurable. It produces profound effects on psychological wellbeing and social functioning and has significant associated co-morbidities. The majority of patients with psoriasis are managed in primary care, however in-depth patient and GP perspectives about psoriasis management in this setting are absent from the literature. This article reports an in-depth study which compares and contrasts the perspectives of people with psoriasis and of GPs on the challenges of managing psoriasis in primary care. METHODS: In-depth, qualitative semi-structured interviews were conducted with a diverse sample of 29 people with psoriasis and 14 GPs. Interviews were coded using principles of Framework Analysis to enable a comparison of patient and practitioner perspectives on key issues and concepts arising from the data. RESULTS: Patients perceived GPs to be lacking in confidence in the assessment and management of psoriasis and both groups felt lacking in knowledge and understanding about the condition. While practitioners recognised that psoriasis has physical, emotional and social impact, they assumed patients had expertise in the condition and may not address these issues in consultations. This resulted in patient dissatisfaction and sub-optimal assessment of severity and impact of psoriasis by GPs. Patients and GPs recognised that psoriasis was not being managed as a complex long-term condition, however this appeared less problematic for GPs than for patients who desired a shared management with their GP incorporating appropriate monitoring and timely reviews. CONCLUSIONS: The research suggests that current routine practice for psoriasis management in primary care is mismatched with the expressed needs of patients. To address these needs, psoriasis must be recognised as a complex long-term condition involving exacting physical, psychological and social demands, co-morbidity and the development of new treatments.General practitioners need to improve both their knowledge and skills in the assessment and management of psoriasis. This in turn will facilitate management of the condition in partnership with patients. Commissioning multi-disciplinary services, which focus on long-term impacts on wellbeing and quality of life, might address current deficits in care.

Item Type: Article
Additional Information: This is the final published version of the article (version of record). It first appeared online via BioMed Central at http://dx.doi.org/10.1186/1471-2296-14-158 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Adult, Aged, Aged, 80 and over, Attitude of Health Personnel, Clinical Competence, Disease Management, Female, General practitioners, General Practitioners, Health Knowledge, Attitudes, Practice, Humans, IMPACT Team, Male, Middle Aged, NICE guidelines, Patient perspectives, Physician-Patient Relations, Primary health care, Primary Health Care, Psoriasis, Qualitative research, Qualitative Research, Self Care, Self-care, Young Adult
Subjects: R Medicine > RL Dermatology
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Related URLs:
Depositing User: Symplectic
Date Deposited: 06 Apr 2017 14:51
Last Modified: 06 Apr 2017 14:51
URI: http://eprints.keele.ac.uk/id/eprint/3197

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