P83 Improving patient care through a collaborative effort in the Leeds Combined Psoriatic Service: an effective provision of multi-specialty input
Authors: Vandevelde Claire , Harnden Kate , Freeston Jane , Barr Andrew , Shams Kave , Laws Philip , Marzo-Ortega Helena 
Published: April 2020

Abstract

Background
NICE guidance (NG65) endorses the need for a multi-specialist approach in spondyloarthritis. The Leeds Combined Psoriatic Service has been running rheumatology and dermatology clinics in parallel since 2011, where patients with psoriatic arthritis (PsA) and psoriasis from both services are reviewed on request by both teams.

Methods
Prospective survey to assess the potential benefits of the current combined review over a 17-month period (May 2018-September 2019). In addition, a patient satisfaction survey was performed in the rheumatology setup.

Results
In a standard month, 120 patients with PsA and 180 with psoriasis are reviewed in each clinic. A total of 136 combined consultations took place during this study period with dermatologists reviewing rheumatology patients on 87 occasions and rheumatology reviewing dermatology patients on 49 occasions. Overall, the combined review had a direct impact on the other specialty’s clinical treatment plan in 32% (44/136). This included altering csDMARDs (16%; 7/44), switching or starting a TNF inhibitor (20%; 9/44), new IL-17 inhibition (41%; 18/44); IL-23 inhibition (19%; 8/44), apremilast (5%; 2/44). Furthermore, 12 Rheumatology patients with PsA were able to access a biological medication for which they didn't fulfil NICE criteria or which is not yet approved for use in PsA, based on their skin involvement (1 secukinumab, 2 ixekizumab, 3 adalimumab, 1 rizankizumab, 5 guselkumab); 2 dermatology patients were able to access biological medication prescribed by rheumatology (1 adalimumab, 1 apremilast). Objectively, combined reviews avoided a separate out-patient appointment on 82 occasions averaging a saving of £21,080 to the CCG. A new rheumatological diagnosis was given to 18 people attending the dermatology clinic (4 spondyloarthritis; osteoarthritis, gout, fibromyalgia or mechanical joint pains) and 34 people were given a new skin diagnosis (3 new psoriasis, 9 fungal rash or possible psoriasis, 2 vasculitis, 17 eczema, rosacea or other). During the past year, 196 patients were recruited to clinical trials in rheumatology and 170 in dermatology conducted studies. The patient satisfaction survey was returned by 108 rheumatology patients. In total, 24% (26 of 108) reported benefitting from a dermatologist’s review whilst attending a rheumatology appointment. 70% of rheumatology patients with psoriasis, who were not already under dermatology, had either seen or would like to have seen a dermatologist whilst attending rheumatology clinic.

Conclusion
Combined clinics give clear patient benefits, with improved clinical decision making, enhanced diagnosis and access to therapies. In addition, they carry substantial savings for the CCGs and lead to high patient satisfaction. These specialised services support pioneering clinical practice and deliver cutting-edge care acting as hubs for translational research within the NHS, and as such should be eligible for high tariff commissioning to allow for fine tuning on the delivery of quality of care and cost control.

Disclosures
C. Vandevelde: None. K. Harnden: None. J. Freeston: None. A. Barr: None. K. Shams: None. P. Laws: None. H. Marzo-Ortega: None.