How remote care can deliver a step change in treatment for inflammatory skin conditions
In the latest in our new series on improving care for people with long-term health conditions, Dods Impact and AbbVie explore how the use of digital images for skin legions can deliver a step change in treatment for inflammatory skin conditions
Inflammatory skin conditions such as psoriasis or eczema can have a profound and debilitating impact on people of all ages. They are also a major issue for NHS capacity. Ask any practicing GP, and they will tell you that skin conditions account for up to a third of all appointments.
Living with an inflammatory skin condition can also have serious consequences for mental as well as physical health. In a recent survey by the APPG on Skin, 93% of respondents said that their skin condition impacted on their self-esteem, 5% reported that they had even contemplated suicide.
Chair of the APPG Sir Edward Leigh, who himself suffers from rosacea, is concerned that the pandemic has had a profound impact on those living with inflammatory skin conditions.
“The waiting time for patients with long-term skin conditions to see a secondary care specialist has been growing for years,” he tells us. “This has only been exacerbated by the pandemic.”
Dominic Urmston, from the Psoriasis Association shares Leigh’s concerns. He has heard from many patients who have had their treatments disrupted.
“During the pandemic many people with inflammatory skin conditions saw face-to-face appointments either changed to remote consultations or cancelled altogether,” he explains. “This has led to an appointment backlog and increased waiting times for specialist care, with many people seeing their symptoms worsen in the meantime.”
Urmston’s experience has now been backed up by a recent report, commissioned and funded by biopharmaceutical company AbbVie and carried out by health research consultancy Carnell Farrar.
The report highlights the impact of the pandemic on the diagnosis and treatment of conditions like eczema and psoriasis. It reports that during the first year of the pandemic first outpatient attendances for dermatology plummeted by 28%, while elective hospital admissions for psoriasis alone fell by the same number. This is one of the largest falls seen within any patient group. As a result, while we know around 300,000 patients are currently on the routine waiting list, the overall backlog of patients could be much higher – one hypothecated model by Carnall Farrar suggests over 900,000 patients were unaccounted for during the first 18 months of the pandemic and are potentially still in need of care.*
“Appointment levels are now slowly recovering,” Todd Manning, General Manager at AbbVie, “but even if they reach pre-pandemic levels that alone will not come close to clearing the backlog created by the pandemic unless new ways can be found to increase capacity within the system to allow more patients to be seen when they need it. All sectors and organisations need to work collaboratively and creatively to find new ways to reach and care for those with inflammatory skin conditions.”
There is however a strong foundation for developing new approaches. Dr Julia Schofield, Dermatology Clinical Lead for NHS England, told us that technology is already playing an important role in delivering better care to those with serious skin conditions.
“The NHS is transforming dermatology outpatient services to ensure that patients have better access to specialist care that works for them,” she explains. “By making better use of technology such as digital images, we are reducing the need for unnecessary face-to-face appointments, and are giving patients the freedom to book outpatient appointments when they need them to ensure care is responsive to their individual condition.”
The use of digital images for the assessment of people, particularly with skin lesions, is already making a difference. Dr Schofield explained that it is helping to reduce the number of people that need to attend hospitals and freeing up capacity for those people, usually with inflammatory skin diseases, that need to be seen face to face in dermatology clinics. As a result there are growing calls for a further acceleration in the rollout of these new approaches and other digitally enabled solutions that support out of hospital care and patient self-management to further reduce capacity pressures.
By making better use of technology such as digital images, we are reducing the need for unnecessary face-to-face appointments, and are giving patients the freedom to book outpatient appointments when they need them to ensure care is responsive to their individual condition.
“Some waiting times are now quoted in years, not months,” Sir Edward Leigh tells us. “New ways of working will have to be trialled and adopted to improve this intolerable situation.”
Todd Manning also believes that the new ways of working that Schofield advocates should be must now be prioritised for adoption.
“Covid saw a massive increase in telephone appointments, but for inflammatory skin diseases diagnosis over the telephone is highly challenging,” he explains. “The use of digital technology is about enabling how the whole system can work more efficiently. Effective sharing of information, particularly between primary and secondary care providers is key. The Carnall Farrar research shows that better use of digital imagery to support the two week wait cancer referral process could save up to 48,000 consultant hours that could be released to increase capacity for eczema and other dermatology cases, reducing anxiety for patients.”
Delivering these benefits will require shifts in how Integrated Care Boards commission dermatology services, more support and education for frontline staff across a patient’s treatment journey to help them understand and deliver new care pathways, and investment in new technologies. This was a recommendation emerging from a recent parliamentary roundtable on the issue chaired by Sir Edward Leigh, alongside the need for more national leadership and accountability to help drive this change.
However, the prize on offer is substantial. The increased use of digital and remote care solutions could lead to speedier diagnoses, better patient outcomes, and more effective use of healthcare resources. Not only will this benefit the millions of people in England living with inflammatory skin conditions, it will also benefit the NHS as a whole - a prize well worth securing.
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One of the ways that new technologies can help patients and speed up processes for GPs and consultants is by enabling diagnosis to take place quickly and without the need for an outpatient appointment.
In Leeds, a project has been looking at ways to deliver fast and accurate diagnoses around lesions that might indicate skin cancers. The scheme began when a consultant dermatologist realised that a third of all patients referred to consultants were ultimately discharged without any clinical intervention.
He realised that if new technology could be used to move these patients through the system more quickly that would reduce anxiety and save time and money for health providers.
Until the new system was put into place, each of these patients would have had to attend a face-to-face appointment. Not only did that lead to anxiety and concern, but it also created pressure on the secondary care system.
The solution that has been put in place to achieve this is a specialist magnifying device that is used with a smartphone. This system is now used by every GP practice in Leeds.
At the initial appointment GPs, with patient consent, take three pictures of any concerning skin lesion. These are then sent securely to the consultants at Leeds Teaching Hospital Trust. Within 48 hours those consultants report back, either confirming the lesion is benign or inviting the patient in for a face-to-face appointment.
The new system is faster, more efficient, and more effective than the traditional way of working. It has reduced anxiety for patients, relieved pressure on the 2 week wait pathway, and freed up the capacity of dermatology consultants.
This case study is not connected to AbbVie in any way
This article and the Carnall Farrar report has been commissioned and funded by AbbVie. This article is intended for the general public. Date of Preparation: September 2022 Job No: UK-ABBV-220308
*HES data Mar 19 – Nov 21. Backlog calculated from accumulated month on month deficit in observed outpatient appointments compared to average month in year prior to COVID (Mar 19 –Feb 20) assuming demographic growth of 3%. 90% of missed activity assumed to flow into backlog. No seasonality and no further disruption assumed
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