Title: The IMPACT Study: Identification and Management of Psoriasis Associated ComorbidiTy
Funder: Department of Health (England)

Abstract: AIM The aim of the programme is to apply the best available knowledge to devise responsive services to improve the care of people with psoriasis. MAJOR OBJECTIVES To devise an evidence based, acceptable, feasible and accessible primary care based intervention to improve self-care and coping for people with psoriasis. To devise evidence based training for primary care staff to improve access to targeted services for people with psoriasis. BACKGROUND Psoriasis is a common, life-long inflammatory skin disease that affects at least 2% of the population. The disease is associated with high levels of physical and psychosocial disability and currently is incurable. Data suggest that many psoriasis patients may be missing out on recent developments in treatment or be self-managing their condition sub-optimally. The poor quality of life experienced by psoriasis patients is not always recognised by the medical profession, particularly in primary care. The relationship between clinical severity of psoriasis and the degree of psychosocial disability relating to the condition is complex. Recent data suggest that severe psoriasis confers an independent risk for development of cardiovascular disease (CVD). The highest relative risk of myocardial infarction appears to be in younger patients with severe psoriasis. These early results are unconfirmed and we do not know if the risk for CVD is also applicable to patients with mild psoriasis. IMPORTANCE OF PROPOSED RESEARCH The majority of psoriasis patients are of working age and the disease is currently incurable. Many patients find consultations unsatisfactory and evidence indicates that psychological and physical comorbidities are poorly managed. RELEVANCE TO PRIORITIES AND NEEDS OF THE NHS As a relatively neglected long-term condition linked with the risk of future detriment to mental and cardiovascular health, psoriasis provides an ideal exemplar for investigating effective management of complex, chronic disease. RESEARCH PLANS We propose five workstreams 1. To provide a definitive picture of the burden of disease in psoriasis patients 2. To apply knowledge about disease risk to the development of targeted screening services to reduce risk of further disease and to investigate how this impacts upon patient experience 3. To learn from patients with psoriasis about effective coping strategies 4. To understand influences upon treatment adherence in people with psoriasis and to identify barriers to providing patients with useful advice about lifestyle modification 5. To devise an evidence based and accessible primary care based intervention to improve self-care and coping for people with psoriasis. To devise evidence based training for primary care staff to improve access to targeted services for psoriasis patients RESEARCH TEAM The psoriasis research programme in Manchester is one of the most comprehensive in the world. The members of this multidisciplinary research team have successful track records of collaborative applied health services research in the fields of psoriasis management, systematic reviews, healthcare delivery and management of chronic diseases and their associated comorbidities in primary and secondary care. RESEARCH ENVIRONMENT Salford PCT and Ashton, Leigh and Wigan PCT have strong connections with dermatology research at Salford Royal Foundation Trust (SRFT) and with the University of Manchester. East Lancs PCT and the Greater Manchester and Cumbria and Lancs Comprehensive Research Networks already work together and the programme will benefit from close links with the newly formed CLAHRC based in Salford and with the Manchester Academic Health Science Centre. The strong organisational relationship between SRFT and Salford PCT provides an ideal research context for this work. OUTPUTS AND IMPACT Outputs include patient self-management resources and staff training packages to improve the lives of people with psoriasis and research publications including systematic reviews. For the NHS there will be accurate information on primary care costs associated with management of psoriasis. Several outputs will be generalisable to other long-term conditions. PUBLIC INVOLVEMENT The Psoriasis Association, a national NIHR partner organisation of patients and carers, has been intimately involved in the design and planning of the programme. Patient representatives are key members of both the research and management teams ETHICAL IMPLICATIONS Each component of the programme of research requires ethical approval from the relevant bodies. Research governance arrangements for each Trust require researchers to hold full or honorary contracts. The main ethical issues include confidentiality of data, anonymity, informed consent to participate, and ability to withdraw at any point without need to provide reasons. JUSTIFICATION FOR RESOURCES REQUESTED The resources requested are commensurate with delivery of a high quality programme resulting in patient benefit.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: SKIN