An expert nurse practitioner and a physician assistant examine the role of collaborative care in the management of plaque psoriasis.
Jayme Heim, MSN, FNP-BC: In practice, do you work with a multidisciplinary plan for your patients with plaque psoriasis? If so, where do you implement that?
Matthew T. Reynolds, PA-C: Yes, and that is becoming more and more essential as our knowledge of plaque psoriasis and all the comorbid conditions becomes more elucidated. We must have a rheumatologist in our back pocket. We must have a gastroenterologist in our back pocket. Close communication with that patient’s primary care provider is also essential. Now, we make decisions for our patients all the time without having someone tell us which drug is right. That’s just a common theme with most APPs [advanced practice providers] nowadays. However, I think it is still very essential that you have a team approach and you do have a multidisciplinary approach for your more complex patients. If you treat enough psoriasis patients, you’re going to have someone that has a complication. You need to have another specialist, another helping hand or a life support on the line that you can get a hold of quickly. In our area, practices such as rheumatologists and GI [gastrointestinal] doctors are fairly scarce, and the wait times are excessive. They’re 6 months or more. If you can, find that 1 guy in your community, find that 1 specialist in your community, that you can call after hours or over a lunch break or even on the weekends if you have a difficult patient, and try to get some guidance. Try to get some help. I think they’re going to be much more appreciative of you asking for guidance versus just doing. Helping your patients is really the endgame here with all of us.
Jayme Heim, MSN, FNP-BC: Thank you, Matt. The other situation that I come across quite a bit is patients who have a history of cancer. They’ll come in and they have terrible psoriasis, and they’ve gone through cancer treatment. When they were on cancer treatment, their psoriasis cleared up. Then now that they’ve been treated, or they’re considered in remission, their psoriasis is just horrible. They come in and they say, “I’ve had cancer, but I’m not sure I can go on a medication that will completely treat my cancer.” What I do is, I collaborate with their oncologist to find out what would be appropriate. I’ve also had patients that had had hepatitis B, and like you said, to make sure you collaborate with a gastroenterologist. Women that come in and they’re pregnant, they want treatment because for all women, pregnancy is not a time that their psoriasis clears up. In fact, for years, I’ve had women that during pregnancy, their psoriasis has gotten much worse. Just by being able to collaborate with their ob-gyn [obstetrician-gynecologist] is wonderful for the patient. Also, I’ll say to women, this is a shared decision with your partner. It’s bringing everybody into the picture, and that’s important to have more of a holistic approach to care. The other thing I would like to mention is the primary care doctors; how many times do we even draw baseline labs and we come back with a glucose that is in the 300s, and a patient is not being treated at all? We can go ahead and send over to that primary care physician labs for the patient, call the patient, have them follow up with the primary care. There are just so many ways that we can collaborate with other providers as APPs in our community to help safeguard our patients, and I think that’s just wonderful.
Transcript edited for clarity