Access Pathway Delays and Burden of Disease for Patients with Severe Chronic Skin Conditions Requiring Systemic and Biologic Therapies at an Irish Dermatology Centre

Abstract

Diseases that directly affect the skin are the fourth most frequent cause of all human illnesses. Despite this, skin diseases continue to receive little attention. Dermatology waiting times in Ireland are longer when compared to other health systems abroad. In this study we highlight a cohort of dermatological patients with inflammatory skin conditions, that require attention with regards to access to dermatological services. Aim of this study was to analyse our patient cohort currently taking biologic therapy to determine how they accessed the hospital system and the time course of transition to systemic and biologics therapy. This was a retrospective study with analysis of patients on biologic agents: etanercept, adalimumab, ustekinumab, infliximab and golimumab for chronic dermatoses from 2006-2012. We identified 157 patients on biologics between this period, with 114 of these patients currently on biologic therapy. Although 55% (62) were seen within 6 months of referral the mean wait from receipt of a GP referral letter to being seen in the outpatient was 11.6 months (range 0-87 months). This study shows that patients with severe inflammatory skin disease face significant delays in accessing the hospital system. This is partly due to inadequate infrastructure and staffing of Dermatology units.