Successful Screening of Undiagnosed Psoriatic Arthritis in Primary Care Utilising Digital Interventions Within a Quality Improvement Programme

Abstract

Background: Despite the advancements in the management of psoriasis (PsO) and psoriatic arthritis (PsA), there remains a significant delay to diagnosis of PsA. National guidelines recommend regular screening of patients with PsO for PsA. The aim of this study was to increase the screening of patients with PsO, and reduce the delay to diagnosis in PsA. Methods: A retrospective baseline audit was conducted in patients with PsO attending a large general practice (Brookside Group Practice, Reading, UK) between November 2022–April 2023. In the follow-up stage between May–November 2023, a digital Egton Medical Information System (EMIS; Emis Health, Rawdon, Leeds, UK) web template, using the Psoriasis Epidemiology Screening Tool (PEST) questionnaire was implemented. The number of patients with PsO screened for PsA, and the number of newly diagnosed PsA cases, were recorded. Results: At baseline, 15 patients with PsO were identified, and none had PsA screening done. In the follow-up phase, 28 patients coded for PsO were identified. There was an increase in the number of patients screened for PsO from 15 to 28, representing an increase of 87% from baseline. From the follow-up group, 12 (43%) patients were screened for PsA. These patients were referred to the specialist clinic, and seven (58%) had confirmed PsA. This represented a population of patients with previously undiagnosed PsA within the general practitioner (GP) surgery. Conclusions: The authors have successfully implemented an integrated and interactive digital screening tool for PsA within the GP system. This has led to an increase in the detection of patients with PsA. This practical and effective approach is in line with national guidelines for early detection, to prevent long-term damage and disability from PsA.