- Email: [email protected]
Skin disease remote education project
OTIS (option tool for itching scalp): An aid tool for the management of itchy scalps
(Poster reference number 4858)
Catherine Oliveres- Ghouty, MD, Paris, France; Charles-Remy Taieb, PhD, PFSA, Boulogne Billancourt, France Objective: Design a tool to guide disease management available to all pharmacists and nondermatologist health professionals in order to provide a solution for the patient. Methods: The development of the questionnaire followed a rigorous methodologic process. The questionnaire was then administered to a representative sample of 1703 French subjects. Results: In France, 21.49% suffers from an itchy scalp. Amongst subjects who reported itching in the last 7 days during their interview, 22.9% said their itching was exclusively on their scalp, 52.5% on their body (not the scalp), and 24.6% experienced itching both on their body and scalp. Amongst subjects who reported itchy scalps, 34.9% also reported excessive desquamation from the scalp, which orients treatment towards management of seborrheic dermatitis (SD). For 60.66% of those suffering from itchy scalps, the diagnosis of SD cannot be given because of a lack of dandruff. Analyzing these subjects’ 3S score showed sensitive scalps in 48.9% of cases (11.8%, very sensitive scalp). For this last group, the health professional should not only provide the patient with immediate relief, but should also refer them to their dermatologist for additional investigation. Discussion: This questionnaire available to nondermatologist health professionals will allow for rapid patient management and referral to dermatologists for those who require more detailed diagnosis. Commercial support: 50% is sponsored by Laboratoires d’Ucray.
EPIDEMIOLOGY & HEALTH SERVICES ADMINISTRATION Biologic experience and systemic medication use among commercially insured psoriasis patients receiving ustekinumab
(Poster reference number 4750)
C. T. Carter, Centocor Ortho Biotech Services, LLC, Horsham, PA, United States; D. B. Smith, IMS Health, Watertown, MA, United States; L. Denny, Centocor Ortho Biotech Services, LLC, Horsham, PA, United States; S. Martin, Centocor Ortho Biotech Services, LLC, Horsham, PA, United States Background: Ustekinumab (UST) was FDA-approved for use in moderate to severe plaque psoriasis (PsO) on September 25, 2009. Historical biologic use and evidence of concomitant systemic medications may be indicators of PsO disease severity. Total annual treatment, monitoring, and office visit costs associated with systemic medications may range from $1197 (methotrexate) to $17,613 (acitretin). No realworld observational data have been published, thus far, examining biologic experience or concomitant systemic medication use of PsO patients receiving UST. Objective: To describe the biologic experience and concomitant systemic medication use of PsO patients initiating UST. Methods: IMS LifeLink database was used to analyze patients with an index medical/pharmacy claim of UST therapy initiated between September 25, 2009 and December 31, 2009. Inclusion criteria were as follows: patients aged $ 18 years at index, $ 1 PsO diagnosis code, and $ 360/180 days pre-/postindex continuous enrollment. Systemic medications included acitretin, azathioprine, cyclosporine, mercaptopurine, methotrexate, mycophenolate mofetil, and sulfasalazine. Results: A total of 112 PsO patients receiving UST were identified from LifeLink. Mean (SD) age was 46 (11) years; 56% were male. The majority (68%; n ¼ 76) of patients had preindex biologic experience. Among the biologic-experienced, 41% received adalimumab, 38% received etanercept, 24% received infliximab, 17% received efalizumab, and 8% received alefacept preindex. Prior to UST, 49% (n ¼ 37) of biologic-experienced patients received biologic and systemic medications. After initiating UST, 12% of UST patients received concomitant systemic medications. Methotrexate, cyclosporine, and acitretin were the only systemic medications observed in the pre-or post-UST period. Conclusion: The majority of patients receiving UST were biologic-experienced. Systemic medication use was evident in nearly half of all biologic-experienced PsO patients prior to UST, but only in approximately 1 in 10 patients after initiating UST. Further research is necessary in a larger sample size, while controlling for baseline clinical and economic factors. Additionally, the safety of concomitant use of UST with immunosuppressants has not been evaluated. Lastly, an evaluation of the impact of biologic experience on UST dosing and the economic impact of UST on use of other PsO medications is warranted. Commercial support: This study was sponsored by Centocor Ortho Biotech Services, LLC. Comorbidity of acne with attention deficit hyperactivity disorder: Results from a nationally representative sample of 5240 patient visits for acne from 1995 to 2008
(Poster reference number 5591)
Results: We found that nurses were eager to participate in further dermatology education. This was reflected in the survey results in which the majority of RCNP nurses revealed that they were not comfortable with their dermatology knowledge. Of 19 nurses who returned surveys at the initiation of the study, 18 reported that their comfort with diagnosing dermatologic conditions was poor or fair and only 1 reported comfort as good, very good, or excellent. Level of support by the dermatology community was rated as poor by 14 of 19 nurses. The estimated training in dermatology was \5 hours for 11 of 19 and 5 to 15 hours for 7 of 19 nurses. Only 1 nurse reported [15 hours of training before beginning the program. Despite limited training, 10 of 19 nurses reported that 10% to 25% of their patients had dermatologic problems and 4 of 19 reported between 25% and 50% of their patients had skin problems. We believe this study demonstrates a clear need for increased education in dermatology for remote nurses and has created an open dialogue between an urban dermatology center and remote locations where health care professionals practice dermatology.
Madhulika A. Gupta, MD, Department of Psychiatry, University of Western Ontario, London, Canada; Aditya K. Gupta, MD, PhD, Divsion of Dermatology, Department of Medicine, University of Toronto, London, Ontario, Canada; Branka Vujcic, Department of Psychiatry, University of Western Ontario, London, Canada Background: Acne has been associated with psychiatric morbidity (eg, major depressive disorder, anxiety disorders, body dysmorphic disorder, and eating disorders) and increased suicide risk; to our knowledge, there are no reported studies that have examined the comorbidity of acne with attention deficit hyperactivity disorder (ADHD). ADHD is a psychiatric disorder with a prevalence of 5% to 7% in school aged children that usually presents before 7 years of age with symptoms related to problems with inattention, with or without hyperactivity/impulsivity (DSM-IV-TR, 2000). In the majority of cases, ADHD is usually relatively stable through early adolescence, with abatement of symptoms during late adolescence and early adulthood. We examined the prevalence of ADHD in acne, which also has a peak prevalence during adolescence, and compared it to the prevalence of ADHD to other dermatologic disorders, specifically atopic eczema, which often also has first onset in childhood. Methods: We examined an estimated 943,432,506 patient visits (unweighted count, 69,349) from 1995 to 2008, with a dermatologic diagnosis (ICD-9-CM codes 680709) in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. There were estimated 101,155,579 (unweighted count, 5240) patient visits with acne (ICD-9-CM code 706.1) and an estimated 172,082,735 (unweighted count, 11, 007) visits with atopic eczema (ICD-9-CM codes 691.8, 692, and 692.9). An ADHD variable was created using ICD-9-CM codes 314.0, 314.00, and 314.01. Statistical analyses including odds ratios (ORs) were calculated using the complex samples module of SPSS version 15. Results: The OR for ADHD in acne versus all dermatology visits was 6.299 (95% CI, 3.237-12.26). The OR for ADHD in atopic eczema versus all dermatology visits was 0.701 (95% CI, 0.335-1.463). Comparison of the frequencies of ADHD in acne versus atopic eczema revealed an OR of 5.606 (95% CI, 2.415-13.014). Comment: Our results from a nationally representative sample of patient visits where data were gathered with no a priori hypothesis reveals a significantly high prevalence of ADHD in acne patients, even compared with other skin disorders that are common in the pediatric age group, such as atopic eczema. This previously unreported finding suggests that the clinician should consider ADHD when evaluating psychiatric morbidity in the acne patient, as this can contribute to problems with adherence to treatment of the acne.
Commercial support: None identified.
Commercial support: None identified.
Skin disease remote education project
(Poster reference number 4689)
Katie Beleznay, Department of Dermatology and Skin Science, Vancouver, Canada; Wingfield Rehmus, MD, MPH, Division of Dermatology, Vancouver, Canada Background: In rural areas, access to dermatologic care is limited, and primary care needs are often met by nonphysician practitioners. Remote Certified Nursing Practice (RCNP) nurses have special training that equips them for general clinical practice in remote areas where there is no resident physician. Skin-related complaints make up a significant portion of primary health care visits, and practitioners often request ongoing training in dermatology. The goal of this project is to provide dermatology education for a target group of these RCNP nurses focusing on the basic skin conditions encountered regularly within their clinics. Project description: This project is designed to provide educational materials to primary providers in remote areas of British Columbia, Canada. The first phase involved recruiting a target group of 22 RCNP nurses. These nurses completed a pretest dermatology quiz and survey. They were then sent a weekly series of cases via e-mail. This case series has been previously used in the Republic of Palau and provides basic education on common skin conditions. Following this first phase, a posttest and survey were distributed to evaluate the effectiveness of the program.
AB86
J AM ACAD DERMATOL
APRIL 2012
(Poster reference number 4858)
Catherine Oliveres- Ghouty, MD, Paris, France; Charles-Remy Taieb, PhD, PFSA, Boulogne Billancourt, France Objective: Design a tool to guide disease management available to all pharmacists and nondermatologist health professionals in order to provide a solution for the patient. Methods: The development of the questionnaire followed a rigorous methodologic process. The questionnaire was then administered to a representative sample of 1703 French subjects. Results: In France, 21.49% suffers from an itchy scalp. Amongst subjects who reported itching in the last 7 days during their interview, 22.9% said their itching was exclusively on their scalp, 52.5% on their body (not the scalp), and 24.6% experienced itching both on their body and scalp. Amongst subjects who reported itchy scalps, 34.9% also reported excessive desquamation from the scalp, which orients treatment towards management of seborrheic dermatitis (SD). For 60.66% of those suffering from itchy scalps, the diagnosis of SD cannot be given because of a lack of dandruff. Analyzing these subjects’ 3S score showed sensitive scalps in 48.9% of cases (11.8%, very sensitive scalp). For this last group, the health professional should not only provide the patient with immediate relief, but should also refer them to their dermatologist for additional investigation. Discussion: This questionnaire available to nondermatologist health professionals will allow for rapid patient management and referral to dermatologists for those who require more detailed diagnosis. Commercial support: 50% is sponsored by Laboratoires d’Ucray.
EPIDEMIOLOGY & HEALTH SERVICES ADMINISTRATION Biologic experience and systemic medication use among commercially insured psoriasis patients receiving ustekinumab
(Poster reference number 4750)
C. T. Carter, Centocor Ortho Biotech Services, LLC, Horsham, PA, United States; D. B. Smith, IMS Health, Watertown, MA, United States; L. Denny, Centocor Ortho Biotech Services, LLC, Horsham, PA, United States; S. Martin, Centocor Ortho Biotech Services, LLC, Horsham, PA, United States Background: Ustekinumab (UST) was FDA-approved for use in moderate to severe plaque psoriasis (PsO) on September 25, 2009. Historical biologic use and evidence of concomitant systemic medications may be indicators of PsO disease severity. Total annual treatment, monitoring, and office visit costs associated with systemic medications may range from $1197 (methotrexate) to $17,613 (acitretin). No realworld observational data have been published, thus far, examining biologic experience or concomitant systemic medication use of PsO patients receiving UST. Objective: To describe the biologic experience and concomitant systemic medication use of PsO patients initiating UST. Methods: IMS LifeLink database was used to analyze patients with an index medical/pharmacy claim of UST therapy initiated between September 25, 2009 and December 31, 2009. Inclusion criteria were as follows: patients aged $ 18 years at index, $ 1 PsO diagnosis code, and $ 360/180 days pre-/postindex continuous enrollment. Systemic medications included acitretin, azathioprine, cyclosporine, mercaptopurine, methotrexate, mycophenolate mofetil, and sulfasalazine. Results: A total of 112 PsO patients receiving UST were identified from LifeLink. Mean (SD) age was 46 (11) years; 56% were male. The majority (68%; n ¼ 76) of patients had preindex biologic experience. Among the biologic-experienced, 41% received adalimumab, 38% received etanercept, 24% received infliximab, 17% received efalizumab, and 8% received alefacept preindex. Prior to UST, 49% (n ¼ 37) of biologic-experienced patients received biologic and systemic medications. After initiating UST, 12% of UST patients received concomitant systemic medications. Methotrexate, cyclosporine, and acitretin were the only systemic medications observed in the pre-or post-UST period. Conclusion: The majority of patients receiving UST were biologic-experienced. Systemic medication use was evident in nearly half of all biologic-experienced PsO patients prior to UST, but only in approximately 1 in 10 patients after initiating UST. Further research is necessary in a larger sample size, while controlling for baseline clinical and economic factors. Additionally, the safety of concomitant use of UST with immunosuppressants has not been evaluated. Lastly, an evaluation of the impact of biologic experience on UST dosing and the economic impact of UST on use of other PsO medications is warranted. Commercial support: This study was sponsored by Centocor Ortho Biotech Services, LLC. Comorbidity of acne with attention deficit hyperactivity disorder: Results from a nationally representative sample of 5240 patient visits for acne from 1995 to 2008
(Poster reference number 5591)
Results: We found that nurses were eager to participate in further dermatology education. This was reflected in the survey results in which the majority of RCNP nurses revealed that they were not comfortable with their dermatology knowledge. Of 19 nurses who returned surveys at the initiation of the study, 18 reported that their comfort with diagnosing dermatologic conditions was poor or fair and only 1 reported comfort as good, very good, or excellent. Level of support by the dermatology community was rated as poor by 14 of 19 nurses. The estimated training in dermatology was \5 hours for 11 of 19 and 5 to 15 hours for 7 of 19 nurses. Only 1 nurse reported [15 hours of training before beginning the program. Despite limited training, 10 of 19 nurses reported that 10% to 25% of their patients had dermatologic problems and 4 of 19 reported between 25% and 50% of their patients had skin problems. We believe this study demonstrates a clear need for increased education in dermatology for remote nurses and has created an open dialogue between an urban dermatology center and remote locations where health care professionals practice dermatology.
Madhulika A. Gupta, MD, Department of Psychiatry, University of Western Ontario, London, Canada; Aditya K. Gupta, MD, PhD, Divsion of Dermatology, Department of Medicine, University of Toronto, London, Ontario, Canada; Branka Vujcic, Department of Psychiatry, University of Western Ontario, London, Canada Background: Acne has been associated with psychiatric morbidity (eg, major depressive disorder, anxiety disorders, body dysmorphic disorder, and eating disorders) and increased suicide risk; to our knowledge, there are no reported studies that have examined the comorbidity of acne with attention deficit hyperactivity disorder (ADHD). ADHD is a psychiatric disorder with a prevalence of 5% to 7% in school aged children that usually presents before 7 years of age with symptoms related to problems with inattention, with or without hyperactivity/impulsivity (DSM-IV-TR, 2000). In the majority of cases, ADHD is usually relatively stable through early adolescence, with abatement of symptoms during late adolescence and early adulthood. We examined the prevalence of ADHD in acne, which also has a peak prevalence during adolescence, and compared it to the prevalence of ADHD to other dermatologic disorders, specifically atopic eczema, which often also has first onset in childhood. Methods: We examined an estimated 943,432,506 patient visits (unweighted count, 69,349) from 1995 to 2008, with a dermatologic diagnosis (ICD-9-CM codes 680709) in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. There were estimated 101,155,579 (unweighted count, 5240) patient visits with acne (ICD-9-CM code 706.1) and an estimated 172,082,735 (unweighted count, 11, 007) visits with atopic eczema (ICD-9-CM codes 691.8, 692, and 692.9). An ADHD variable was created using ICD-9-CM codes 314.0, 314.00, and 314.01. Statistical analyses including odds ratios (ORs) were calculated using the complex samples module of SPSS version 15. Results: The OR for ADHD in acne versus all dermatology visits was 6.299 (95% CI, 3.237-12.26). The OR for ADHD in atopic eczema versus all dermatology visits was 0.701 (95% CI, 0.335-1.463). Comparison of the frequencies of ADHD in acne versus atopic eczema revealed an OR of 5.606 (95% CI, 2.415-13.014). Comment: Our results from a nationally representative sample of patient visits where data were gathered with no a priori hypothesis reveals a significantly high prevalence of ADHD in acne patients, even compared with other skin disorders that are common in the pediatric age group, such as atopic eczema. This previously unreported finding suggests that the clinician should consider ADHD when evaluating psychiatric morbidity in the acne patient, as this can contribute to problems with adherence to treatment of the acne.
Commercial support: None identified.
Commercial support: None identified.
Skin disease remote education project
(Poster reference number 4689)
Katie Beleznay, Department of Dermatology and Skin Science, Vancouver, Canada; Wingfield Rehmus, MD, MPH, Division of Dermatology, Vancouver, Canada Background: In rural areas, access to dermatologic care is limited, and primary care needs are often met by nonphysician practitioners. Remote Certified Nursing Practice (RCNP) nurses have special training that equips them for general clinical practice in remote areas where there is no resident physician. Skin-related complaints make up a significant portion of primary health care visits, and practitioners often request ongoing training in dermatology. The goal of this project is to provide dermatology education for a target group of these RCNP nurses focusing on the basic skin conditions encountered regularly within their clinics. Project description: This project is designed to provide educational materials to primary providers in remote areas of British Columbia, Canada. The first phase involved recruiting a target group of 22 RCNP nurses. These nurses completed a pretest dermatology quiz and survey. They were then sent a weekly series of cases via e-mail. This case series has been previously used in the Republic of Palau and provides basic education on common skin conditions. Following this first phase, a posttest and survey were distributed to evaluate the effectiveness of the program.
AB86
J AM ACAD DERMATOL
APRIL 2012