P21 Development of a novel multidisciplinary care model for screening and managing patients with psoriatic arthritis: consensus guidance for primary care providers in Canada
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.030 | 0.041 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.010 | 0.003 |
| Scholarly communication | 0.006 | 0.002 |
| Open science | 0.003 | 0.006 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".