番茄社区

At the American College of Rheumatology (ACR) virtual annual meeting this year, new studies were presented on optimizing shared decision-making and leveraging digital technology for patient care.

In this last of four exclusive episodes, 番茄社区 brought together three expert leaders in the field, all from the Cleveland Clinic -- moderator M. Elaine Husni, MD, MPH, is joined by Leonard Calabrese, DO, and Anthony Fernandez, MD, PhD -- for a virtual roundtable discussion about challenges in patient-clinician communication as well as digital technology tools for psoriatic arthritis (PsA) care.

Following is a transcript of their remarks:

Husni: Welcome. Thanks for joining us on this virtual roundtable for ACR Convergence 2021. Today, I'm really honored to have my good friends and colleagues here, Lenny and Tony. I have asked them to provide their opinions regarding some exciting abstracts at this year's Convergence meeting around psoriatic arthritis.

So I want to just pick your brains about another set of interesting abstracts here, leveraging digital technology for psoriatic disease care. So we talk a lot about including both patient and physician outcomes into many of our trials.

I picked this particular abstract . And these were done with focus groups, looking at patients and physicians -- there are areas that they agreed and areas that they disagreed. So the area that they agreed on was around pain and disease-activity measures as important. But the things that patients and physicians differed on were how physicians ranked enthesitis and dactylitis, and patients would rank access to care, future health and uncertainty (so prognosis), and sleep quality. So that's what patients in these focus groups said. So, love you to reflect on how we can close that gap. Tony or Len, who wants to go first.

Calabrese: I will, because you know this is the favorite topic of mine. I think that, I tell all the fellows they're very good at taking histories of chief complaints, but they're not very good at taking history of patients' chief concerns. And numerous studies have demonstrated that a third or more patients are discordant between what the provider thinks is going on and what the patient thinks is going on. This is just the reality of life. And, our solution to this is that you can't treat a single target, you need two targets. One that is oriented to the disease and the inflammatory process, and the other is organized to the concern of the patient.

Husni: I love that -- complaints vs concerns. Thank you. Tony, how about closing the gap on patients and physicians?

Fernandez: Yeah I think it's as Lenny mentioned, it's important to know what is bothering the patient about this disease. I think as physicians who run busy practices we're used to being in a workflow where we assume what we need to do, but just taking a minute to ask patients what is bothering them, what concerns they have, can be eye-opening. And I think, you know, some of the discrepancies here maybe can be just addressed in a clinic visit with just a little bit of education to put a patient at ease. So just knowing there are discrepancies I think is important for us as physicians to take back to the clinic and take better care of our patients.

Husni: I agree, really empowering the patient. But as we all know, the time at our clinic is sort of shrinking and the question is -- every day there's a new metric that I need to get, and so that leads me to the next abstract about , or patient-reported outcomes, with digital solutions. So is this really a solution? So Len do you think that being able to track a patient's PROs and having that information ahead of time where they can do it right before the visit -- how can we leverage this digital technology?

Calabrese: Obviously in our clinic we collect a lot of patient-reported outcomes. And a mere glance at patient-reported outcomes often is very telling. A patient has high physical function but mental function is down. It can add a question -- you're looking kind of sad today or something seems to be bothering you. Empathic communication with a patient has been demonstrated not to appreciably add to the time of the visit, and in fact, when patients feel that they're being dealt with empathically, they actually think that they have spent longer with the doctor then they actually have, not shorter. So, I am so heartened to see this conversation come up right now. And I think this is the direction we need to take.

Husni: Excellent, that's really helpful. Tony, anything you're doing in dermatology?

Fernandez: I know the abstract you're talking about, and what I really thought was interesting about it is how this group used those patient-reported outcomes to really dictate how often they saw patients. And they also collected data suggesting that there was cost savings and time savings for physicians. So I think it's really interesting data. But what I would like to see is in the real world if doing these types of exercises, do the patient-reported outcomes really correlate with physician outcomes with disease outcomes. Is there really lower risk of comorbid disease in psoriasis, whether that's psoriatic arthritis, radiologic progression of disease in psoriatic arthritis, cardiovascular events, etc. But again, I think this is exciting data that warrants further study.

Husni: That's really interesting Tony, you're really kind of pushing our bar up. So you're saying, we have all this data that we're collecting and you know Len and I have something called MyRheum in rheumatology where we are collecting all those PROs. And I think you bring up a really interesting point which is, OK now that we have this, is it actionable, are we able to do something with this data that's actually going to improve their outcomes long term? So I appreciate that thought.

Well thank you. This has been interesting to reflect on. I know that it's been a really exciting meeting, and I think we've done it well digitally -- virtually, I should say. So that was really interesting for us to really get this right within the second year of the pandemic. But any parting thoughts Len and Tony?

Calabrese: No, you did a great job. I hope to be live in Philadelphia next year.

Husni: Awesome.

Fernandez: Yes, for sure.

Husni: All right, thanks for sharing in this game and reflecting. I learned a lot listening to the both of you, so thanks for that co-management approach.

Watch the first episode of the roundtable: Exploring the Potential of Guselkumab in Psoriatic Arthritis

Watch the second episode of the roundtable: TYK2 Inhibitors Show Efficacy in Psoriatic Arthritis

Watch the third episode of the roundtable: What Factors Predict a Shorter Transition From Psoriasis to PsA?

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