Arsenjeva Jana, Kruus Priit, Hallik Riina, Matasova Secil, Prett Laura, Kaarna Katrin, Raam Liisi, Taul Oliver, Ilves Liis, Viljar Kaisa, Konno Pille, Ross Peeter, Kingo Külli
Tallinn University of Technology, Tallinn, Estonia.
Dermtest OÜ, Tallinn, Estonia.
J Med Internet Res. 2025 Jun 3;27:e73664. doi: 10.2196/73664.
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.
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.
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.
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.
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.
远程监测在银屑病护理中越来越常用，国际银屑病理事会认可远程皮肤病学（TD）作为面对面就诊的可行替代方案。虽然有证据支持由专科医生主导的远程监测，但关于其在初级保健中的有效性的研究有限。在初级和专科护理层面都开展了一项由公共报销的远程监测项目试点，从而能够对生活质量结果进行比较分析，并深入了解有助于改善管理结果的因素。
本研究旨在评估初级和专科护理层面远程银屑病监测的可行性和有效性，并确定与初级保健中改善结果相关的因素。
本研究采用回顾性聚合平行混合方法，分析了2022年1月至2023年7月期间在7个家庭医学中心和1个门诊皮肤性病中心参加公共报销远程监测项目的110名患者的数据。数据来源为公共保险理赔和一个TD平台，该平台记录了皮肤病生活质量指数（DLQI）及相关指标。通过比较基线和平均DLQI分数来评估两个护理层面远程监测的有效性；最小临床重要差异（MCID）定义为≤ -3。计算优势比以比较不同护理层面的结果。相关性分析检验了DLQI变化与诸如基线银屑病面积和严重程度指数、人口统计学特征以及电子咨询使用情况等变量之间的关联。对患者反馈和系统可用性调查的定性见解进行分析，以说明护理过程中的差异。
专科护理组（n = 39）的DLQI平均显著降低了 -1.33（P = 0.01），而初级护理组（n = 37）的变化不显著，为 -0.34（P = 0.36）。与初级护理组的患者相比，接受专科护理的患者实现临床显著改善（MCID≤ -3）的可能性高3.91倍（P = 0.04）。初级保健提供者（PCP）与专科医生之间的协作护理与初级护理层面DLQI分数更有利的变化相关（r = -0.339，P = 0.04）。对在初级保健中实现MCID的患者进行的病例系列分析显示管理方法存在差异，包括结合协作护理要素的PCP主导模式和未进行此类协作的护士主导模式。
本研究首次比较了专科和初级护理层面的远程银屑病监测。虽然远程管理在专科护理中被证明是有效的，但初级护理中的结果不显著，这反映了在由PCP主导的面对面护理中所观察到的模式。利用公共理赔数据，该研究强调通过标准化电子咨询将专科支持整合到由PCP主导的护理中可能会改善患者结果。它强调了在银屑病远程管理中进一步研究以及开发PCP与专科医生之间标准化协作护理模式的必要性。
