P21 Development of a novel multidisciplinary care model for screening and managing patients with psoriatic arthritis: consensus guidance for primary care providers in Canada

Abstract There is an unmet need for timely assessment and diagnosis of psoriatic arthritis (PsA) in patients with psoriasis (PsO) and a lack of standardized clinical guidance for primary care providers (PCPs) for supporting the screening and management of these patients. Our study aimed to develop consensus guidance for screening and managing PsA in patients diagnosed with PsO, and identify potential roles for pharmacists within the multidisciplinary care team to facilitate timely specialist access. We used a modified DELPHI process to gather insights on screening practices, quality of life (QoL) monitoring, and lifestyle counselling from 11 Key Opinion Leaders across Canada, including pharmacists, rheumatologists, and dermatologists. Key questions that address current care gaps within each category were identified, and the extent of agreement was determined through two rounds of voting. The threshold for designating consensus for each question was ≥75% agreement. After two rounds of voting, the following recommendations for the multidisciplinary screening and management of PsA in patients with PsO were identified: (i) screening for PsA should be performed by dermatologists or family physicians; (ii) all patients diagnosed with PsO should be screened every 6–12 months; (iii) screening should rely on clinical judgement with a focus on swollen and tender joints, though validated screening tools can be used in the absence of adequate clinical judgement, which can be administered via virtual/telephone appointments; (iv) patients flagged through virtual screening should have an in-person follow-up assessment with their PCP or dermatologist, followed by referral to a rheumatologist if deemed necessary; (v) dermatologists and rheumatologists should be responsible for monitoring QoL in patients with PsO and PsA, respectively, with the method of assessment at the discretion of the responsible HCP; (vi) pharmacists are best positioned to review adherence to biologic therapy at each medication refill, manage injection site reactions, monitor drug safety, and assist with navigating reimbursement; and (vii) pharmacists should counsel patients on health and lifestyle factors such as smoking, alcohol consumption, and maintaining healthy body weight, advise patients on all appropriate vaccines, and counsel patients on the importance of staying up to date on vaccinations. This consensus-derived guidance provides a valuable and novel framework for the multidisciplinary management of PsA in Canada, with pharmacists being uniquely positioned to help address some of the current gaps in care. Implementing these best practices has the potential to reduce delays in diagnosing and initiating treatment for PsA in patients with PsO and improve overall patient ­outcomes.

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