Remote Monitoring of Psoriasis: Comparing Care Models and Evaluating Quality of Life Outcomes: Mixed Methods Study.

BACKGROUND

Remote monitoring is increasingly used in psoriasis care, with the International Psoriasis Council endorsing teledermatology (TD) as a feasible alternative to in-person visits. While evidence supports specialist-led remote monitoring, limited research exists on its effectiveness in primary care. A publicly reimbursed remote monitoring program was piloted at both primary and specialist care levels, enabling comparative analysis of quality of life outcomes and offering insights into factors contributing to better management outcomes.

OBJECTIVE

This study aims to evaluate the feasibility and effectiveness of remote psoriasis monitoring at both primary and specialist care levels, and to identify factors associated with improved outcomes in primary care.

METHODS

This study used a retrospective convergent parallel mixed methods approach to analyze data from 110 patients enrolled in a publicly reimbursed remote monitoring program between January 2022 and July 2023, across 7 family medicine centers and 1 outpatient dermatovenerology center. Data sources were public insurance claims and a TD platform, which captured the Dermatology Life Quality Index (DLQI) and related metrics. The effectiveness of remote monitoring at both care levels was assessed by comparing baseline and average DLQI scores; a minimal clinically important difference (MCID) was defined as ≤-3. Odds ratios were calculated to compare outcomes between care levels. Correlation analysis examined associations between DLQI changes and variables such as baseline Psoriasis Area and Severity Index, demographics, and use of e-consultations. Qualitative insights from patient feedback and system usability surveys were analyzed to illustrate variability in care processes.

RESULTS

The specialist care group (n=39) showed a significant mean reduction in DLQI of -1.33 (P=.01), whereas the primary care group (n=37) demonstrated a nonsignificant change of -0.34 (P=.36). Patients receiving specialist care were 3.91 times more likely to achieve a clinically significant improvement (MCID≤-3) compared with those in primary care (P=.04). Collaborative care between primary care providers (PCPs) and specialists was associated with more favorable changes in DLQI scores at the primary care level (r=-0.339, P=.04). Case series analysis of patients achieving MCID in primary care revealed variability in management approaches, including PCP-led models incorporating collaborative care elements and nurse-led models without such collaboration.

CONCLUSIONS

This study is the first to compare remote psoriasis monitoring across specialist and primary care levels. While remote management proved effective in specialist care, outcomes in primary care were nonsignificant, reflecting patterns seen in in-person PCP-led care. Using public claims data, the study highlights that integrating specialist support into PCP-led care via standardized e-consultations may enhance patient outcomes. It underscores the need for further research and the development of standardized collaborative care models between PCPs and specialists in the remote management of psoriasis.