Objectives: Patients affected by hidradenitis suppurativa (HS) still face a complex journey across many different health-care providers in Europe. The general practitioner (GP) is a key figure in many European public health systems, delivering primary care also for chronic inflammatory skin diseases, advising and referring patients to specialized, second or third-level care facilities. In Italy, the role of the GP in the management of HS is poorly defined, especially in regions with medical budget constraints. The aim of our project was to identify relevant practice gaps in the clinical management of HS in the primary care setting and to propose a clinical framework for an integrated care model of HS patients across primary and specialized care, in Italy. This initiative based on the collaboration between dermatologists, involved in HS care in a third-level hospital setting, and primary care physicians. Methods: a panel of primary care physicians and dermatologists, with a special focus on HS, identified research questions and key-items for the primary care of HS patients in Italy. Current data on key-aspects of disease awareness, definition and clinical management were captured among a representative sample of GPs in Italy via online-questionnaires. Results: the online survey involved 177 GPs across different Italian regions. Relevant practice gaps were identified, involving disease definition, disease coding in electronic patient management software tools and management of HS disease. Initial clinical management of HS patients was performed directly by GPs in >80% of cases, with administration of symptomatic therapy, mostly based on systemic antibiotics (79.9%), topical antibiotics (45,2%) and topical antiseptics (34.07%). Referral to dermatology consultation for diagnostic validation of HS disease was low (10%) in our survey. Awareness and prevalence of known risk factors and systemic-metabolic comorbidities of HS in the survey sample were consistent with previous registry-based epidemiological data. A framework for collaboration between primary care and specialized, third-level clinical centres for HS care was thus proposed, with an emphasis on adherence to Italian and European clinical practice guidelines for HS and management of systemic-metabolic comorbidities of HS. Conclusion: an effective collaboration between primary care and specialized dermatological care is crucial for optimal clinical management of HS, as most patients with initial signs and symptoms of the disease are managed by GPs. Our proposed clinical framework aims to improve early diagnosis of HS and supporting a circle of visits between GPs and specialized HS dermatological services, to improve an integrated care of HS disease and related metabolic and systemic comorbidities. The project framework and clinical tools for primary care of HS patients will be available online for GPs, to be implemented in the clinical practice across Italy.
Integrating primary and dermatological care for hidradenitis suppurativapatients: a survey among general practitioners in Italy and proposal for a clinical algorithm
Garcovich, Simone;
2017-01-01
Abstract
Objectives: Patients affected by hidradenitis suppurativa (HS) still face a complex journey across many different health-care providers in Europe. The general practitioner (GP) is a key figure in many European public health systems, delivering primary care also for chronic inflammatory skin diseases, advising and referring patients to specialized, second or third-level care facilities. In Italy, the role of the GP in the management of HS is poorly defined, especially in regions with medical budget constraints. The aim of our project was to identify relevant practice gaps in the clinical management of HS in the primary care setting and to propose a clinical framework for an integrated care model of HS patients across primary and specialized care, in Italy. This initiative based on the collaboration between dermatologists, involved in HS care in a third-level hospital setting, and primary care physicians. Methods: a panel of primary care physicians and dermatologists, with a special focus on HS, identified research questions and key-items for the primary care of HS patients in Italy. Current data on key-aspects of disease awareness, definition and clinical management were captured among a representative sample of GPs in Italy via online-questionnaires. Results: the online survey involved 177 GPs across different Italian regions. Relevant practice gaps were identified, involving disease definition, disease coding in electronic patient management software tools and management of HS disease. Initial clinical management of HS patients was performed directly by GPs in >80% of cases, with administration of symptomatic therapy, mostly based on systemic antibiotics (79.9%), topical antibiotics (45,2%) and topical antiseptics (34.07%). Referral to dermatology consultation for diagnostic validation of HS disease was low (10%) in our survey. Awareness and prevalence of known risk factors and systemic-metabolic comorbidities of HS in the survey sample were consistent with previous registry-based epidemiological data. A framework for collaboration between primary care and specialized, third-level clinical centres for HS care was thus proposed, with an emphasis on adherence to Italian and European clinical practice guidelines for HS and management of systemic-metabolic comorbidities of HS. Conclusion: an effective collaboration between primary care and specialized dermatological care is crucial for optimal clinical management of HS, as most patients with initial signs and symptoms of the disease are managed by GPs. Our proposed clinical framework aims to improve early diagnosis of HS and supporting a circle of visits between GPs and specialized HS dermatological services, to improve an integrated care of HS disease and related metabolic and systemic comorbidities. The project framework and clinical tools for primary care of HS patients will be available online for GPs, to be implemented in the clinical practice across Italy.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
