Department of Dermatology, King Khalid University, Abha, Saudi Arabia.
Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA.
Clin Exp Dermatol. 2021 Mar;46(2):270-275. doi: 10.1111/ced.14390. Epub 2020 Nov 4.
Multispeciality clinics, such as combined psoriasis-psoriatic arthritis clinics, have shown improved outcomes in various diseases. At Massachusetts General Hospital, we are entering our ninth year of having an interdisciplinary Rheumatology-Dermatology (R-D) clinic.
To evaluate the contribution of an R-D clinic by comparing care of patients pre- and post-evaluation in the combined clinic. As proxies of care, rates and comprehensiveness of evaluations (capillaroscopic examination, skin and joint examination) were compared between the combined clinic and standard Rheumatology or Dermatology clinic.
This was a retrospective chart review of patients at the R-D clinic in Massachusetts General Hospital during the period November 2012 to December 2017.
Prior to the patients visiting the R-D only 5% of capillaroscopic examinations were documented, only 5% of rheumatologists specifically described a rash even when present, and pruritus was documented in only 6% of rheumatology notes. By contrast, in the R-D clinic, capillaroscopic, skin and joint examinations were documented in 100% of visits, and 19% of patients were given a different or a refined diagnosis. Although all our patients had cutaneous manifestations of their disease (hair loss, rash, itch, Raynaud phenomenon, ulcerations, calcinosis) only 34% had seen a dermatologist prior to the combined clinic and only 5% of those had had their concerns addressed by the rheumatologist. This suggests that 95% had a more complete evaluation and management of all aspects of their disease by attendance at the R-D clinic.
Despite this study being limited by its retrospective nature, we found that it is an efficient model to achieve more comprehensive and potentially lower medication costs. Collaboration between dermatologists and rheumatologists in a combined clinic led to more complete skin and joint examinations, consistent tracking of capillaroscopic examination, better description of rash and improved management. Having this clinic helped in reaching a diagnosis and overall better disease control and outcome.
多专科诊所，如银屑病关节炎联合诊所，已在各种疾病中显示出改善的结果。在马萨诸塞州综合医院，我们进入了第 9 年的跨学科风湿病学-皮肤科（R-D）诊所。
通过比较联合诊所评估前后患者的护理情况，评估 R-D 诊所的贡献。作为护理的替代指标，比较联合诊所与标准风湿病学或皮肤科诊所的评估率和全面性（毛细血管镜检查、皮肤和关节检查）。
这是对马萨诸塞州综合医院 R-D 诊所 2012 年 11 月至 2017 年 12 月期间的患者进行的回顾性图表审查。
在患者就诊于 R-D 诊所之前，只有 5%的毛细血管镜检查有记录，即使存在皮疹，只有 5%的风湿病学家专门描述过皮疹，只有 6%的风湿病学记录中记录了瘙痒。相比之下，在 R-D 诊所，毛细血管镜检查、皮肤和关节检查在 100%的就诊中都有记录，19%的患者得到了不同或更细化的诊断。尽管我们所有的患者都有疾病的皮肤表现（脱发、皮疹、瘙痒、雷诺现象、溃疡、钙化），但在联合诊所之前只有 34%的患者看过皮肤科医生，而只有 5%的患者的担忧得到了风湿病学家的关注。这表明，95%的患者通过参加 R-D 诊所，对疾病的各个方面进行了更全面的评估和管理。
尽管这项研究受到其回顾性性质的限制，但我们发现，这是一种实现更全面和潜在更低药物成本的有效模式。皮肤科医生和风湿病学家在联合诊所的合作导致了更全面的皮肤和关节检查、毛细血管镜检查的一致跟踪、皮疹描述的改善以及管理的改善。开设这个诊所有助于做出诊断和整体更好的疾病控制和结果。
