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June 2013

Access to Health Care in Patients With Psoriasis and Psoriatic Arthritis: Data From National Psoriasis Foundation Survey Panels

Author Affiliations

Author Affiliations: Department of Dermatology, University of California at San Francisco, San Francisco (Dr Bhutani); University of Utah School of Medicine, Salt Lake City (Ms Wong); National Psoriasis Foundation, Portland, Oregon (Dr Bebo); and Department of Dermatology, University of California at Davis, Sacramento (Dr Armstrong).

JAMA Dermatol. 2013;149(6):717-721. doi:10.1001/jamadermatol.2013.133

Importance This article represents a real-world perspective on access to health care including the number and types of physicians seen by patients with psoriasis. It is important for practicing dermatologists to recognize patients who may be less likely to seek care for this multifaceted systemic disease as well as to be aware of reasons for not seeing physicians.

Objectives To examine the relationship between psoriasis patient characteristics and access to health care and to determine out-of-pocket costs for psoriasis care.

Design Cross-sectional survey.

Setting Patients with psoriasis and psoriatic arthritis in the general community in the United States.

Participants A random sample of patients with psoriasis and psoriatic arthritis from more than 75 000 National Psoriasis Foundation members.

Main Outcomes and Measures Number and type of physicians seen in the past 2 years and out-of-pocket health care expenses were measured.

Results Among 5604 patients with psoriasis and psoriatic arthritis, 92.4% had seen at least 1 physician in 2 years. Compared with males, female patients with psoriasis were 1.47 times more likely to seek care (adjusted odds ratio, 1.47; 95% CI, 1.18-1.83). Patients with private insurance and Medicare were more likely to seek care compared with uninsured patients (adjusted odds ratio, 3.02; 95% CI, 2.23-4.08 and 2.85; 1.91-4.24, respectively). Among patients with psoriasis seeking care, 78.3% were seeing specialists; 22% obtained care from primary care physicians. Primary reasons for not seeking treatments included giving up on disease treatment (27.6%) and prohibitive cost (21%). Compared with patients with mild disease, patients with severe psoriasis were more likely to seek a specialist for care (adjusted odds ratio, 1.64; 95% CI, 1.37-1.98). Patients spent an average of $2528 out-of-pocket per year for psoriasis care.

Conclusions and Relevance About one-quarter of patients seek psoriasis care from primary care physicians, and insurance status affects care-seeking patterns. Giving up on treatment and prohibitive costs remain primary reasons for not seeking care.