Understanding eligibility creep in psoriasis assessments: a survey study.

Psoriasis severity assessments for clinical trial entry may be unintentionally overestimated, especially if trial eligibility is chiefly dependent on rating of disease severity. When this results in patients with less severe phenotypes joining clinical trials it is referred to as eligibility creep. We investigated the potential impact of psychosocial incentives on psoriasis lesion severity grading. A survey was constructed and disseminated through Amazon Mechanical Turk. Participants completed two vignette-style questions prompted with a randomly allocated psychosocial incentive. Questions required participants to grade and select psoriasis lesion pictures for a fictional trial. Participants also decided whether or not to schedule re-evaluation of patients deemed ineligible at initial visit. There were 646 participants. There was no significant difference in number of total lesions selected for study inclusion between incentive groups (Kruskal-Wallis, P=0.30). In general, participants completing empathy and professional uncertainty incentives selected the most and least number of lesion pictures for trial inclusion, respectively. Participants prompted with empathy incentives had significantly greater rates of choosing to schedule a follow-up visit for ineligible patients compared to participants prompted with other incentives (69.7% versus 59.1%, Chi square P=0.046). Situations evoking empathy may contribute to eligibility creep.

Reassurance Techniques Do Not Significantly Impact Confidence in Biosimilars for Psoriasis: A Survey of a Convenience Sample of Individuals with Self-Identified Psoriasis.

INTRODUCTION: Biosimilars are underutilized, and negative perceptions may hinder their acceptance by patients. Psychologic interventions have not been extensively studied in the context of alleviating biosimilar hesitancy. The objective of this study was to assess the effectiveness of psychologic interventions on biosimilar confidence. METHODS: Following institutional review board (IRB) approval, 1285 subjects with self-reported psoriasis were recruited using Amazon Mechanical Turk, an online crowdsourcing platform. Participants were randomized to one of ten groups. Group A started with a hypothetical bio-originator; group B started with a hypothetical biosimilar. The remaining groups were provided a hypothetical scenario in which they were switching to a biosimilar after achieving great results with a bio-originator, and were randomized to receive either no reassurance (group C) or one of the following psychologic interventions: reassurance of comparable effectiveness (group D), an illustration implying comparable effectiveness (group E), anecdote of great results obtained in "other psoriasis patients" (group F), anecdote of great results obtained in another psoriasis patient "a lot like you" (group G), reassurance of the rigorous evaluation process to gain Food and Drug Administration (FDA) approval (group H), engagement in a task designed to facilitate recognition of biosimilars' comparability through answering multiple choice (group I) or free response questions (group J). Confidence levels were assessed using six-point Likert scales and analyzed using one-way analysis of variance (ANOVA) and two-group t-tests. RESULTS: While no statistically significant differences were detected, illustrations implying comparability (mean 4.19), explanations of the rigorous process to gain FDA approval (mean 4.21), testimonials of treatment success in another psoriasis patient "a lot like you" (mean 4.07) and "other psoriasis patients" (mean 4.01), and engagement with multiple choice (mean 4.02) and free response answers (mean 4.08) improved biosimilar confidence compared with the biosimilar switch control group (mean 3.96). CONCLUSION: Identifying highly impactful methods of improving biosimilar confidence remains a challenge.

The effect of physician appearance on patient perceptions of treatment plans.

The presentation of a physician's clothing and themselves is an important part of the physician-patient interaction. Physician attire can impact patient satisfaction and trust in their physician. We sought to discover the influence physician attire may have on patients' comfort level with proposed treatment plans, which could influence treatment adherence. We surveyed 495 subjects to better understand the relationship between physician attire and patients' perceptions of treatment plans. We found subjects' comfort level in proposed treatment plans was not significantly affected by physician attire. This finding suggests physician attire may not be as important when considering the potential effect on treatment adherence.

Assessing the utility of the decoy effect on biologic treatment preference.

BACKGROUND: Many patients struggle with choosing and adhering to biologics. Psychological approaches (e.g. decoy effect) may impact patients' choices when selecting a biologic. OBJECTIVE: Assess whether decoy options influence choice between injectable treatment options. METHODS: Following IRB approval, 750 subjects >18 years were recruited through MTurk. Subjects were randomized in a 1:1:1 ratio into the following groups: 1) baseline comparison between a more effective, weekly injection and a less effective, every-three-month injection; 2) baseline with a decoy inferior to the weekly injection; 3) baseline with a decoy inferior to the every-three-month injection. Treatment preference was self-reported and compared using chi-square tests. RESULTS: Sixty-six percent of subjects preferred the weekly injection versus 34% for the every-three-month injection (group 1). There was a 4% increase in the number of subjects who preferred the weekly injection (70%; group 2; P=0.34) and a 3% increase for the every-three-month injection (37%) when a decoy inferior to them was included (group 3; P=0.56). CONCLUSION: Psychological approaches can be used to enhance treatment initiation and adherence. However, the decoy effect did not appear to have a significant impact in this study. Patients' preferences for efficacy versus frequency of injection may be rather fixed.

Differences in healthcare barriers based on racial and/or ethnic background for patients with psoriasis.

BACKGROUND: Nonwhite patients have more severe psoriasis and poorer quality of life. A racial, ethnic, and/or cultural gap exists for patients suffering from psoriasis. OBJECTIVES: To assess whether the disparity in psoriasis care stems from differences in perception of psoriasis and/or healthcare barriers based on racial or ethnic background. METHODS: An online survey was given to subjects with a self-reported diagnosis of psoriasis to assess healthcare barriers (n = 302). Subjects were randomized to receive one of two online surveys: mild psoriasis vs. severe psoriasis. Outcome measures were evaluated on a 10-point Likert scale between subjects with a self-reported race or ethnic background as white and nonwhite. Comparisons were analyzed using single-factor ANOVA, two-group t-tests, and chi-squared analysis. RESULTS: Compared to the white population, the nonwhite population more frequently reported lack of culturally competent care as one of the largest barriers to seek psoriasis treatment (p=.01). The nonwhite population also reported high cost of care to be a more significant barrier to seek medical care (p=.02). CONCLUSIONS: If providers better understand the differences in perception of psoriasis and barriers to seek medical care based on racial and/or ethnic background, they can potentially improve the way they interact with patients and present treatment.

Advertising techniques increase biologic treatment willingness in patients with psoriasis.

BACKGROUND: Although biologics have revolutionized psoriasis care, some patients may be reluctant to consider implementing biologic therapy. OBJECTIVE: To determine whether willingness to take a biologic is increased by commonly used advertising techniques. METHODS: An online survey was used to assess subjects with a self-reported diagnosis of psoriasis and their willingness to initiate biologic treatment (N=400). Subjects were randomized to receive one of the following surveys: clinical data with positive framing (N=80), bandwagon-based statement (N=80), testimonial-based statement (N=80), comparative advertising (N=80), and negative framing (N=80). Willingness to take treatment was recorded on a 10-point Likert scale and evaluated using one-way ANOVA, two-group t-tests, and chi-squared tests. RESULTS: Compared to subjects presented with positive framing (M=5.5, SD=3.2), subjects presented with a bandwagon-based statement (M=6.5, SD=2.7; P=0.04) and testimonial-based statement (M=7.0, SD=2.7; P=0.01) reported a greater willingness to take treatment, whereas negative framing (M=4.5, SD=3.0; P=0.03) decreased willingness and comparative advertising (M=5.5, SD=2.7; P=0.96) yielded the same willingness as positive framing. CONCLUSION: Providers might be able to enhance biologic acceptance by utilizing commonly used advertising techniques, such as the bandwagon effect, testimonial effect, and positive framing.

The ethical implications of utilizing advertising techniques to increase biologic treatment willingness in patients with psoriasis.

Certain techniques used in the advertising and marketing setting may enhance patient willingness to initiate and adhere to treatment. Some methods include manipulation, nudging, bandwagon effect, testimonial effect, and framing. While these tools may improve patient adherence to certain medications, and thus overall health-related outcomes, the ethical implications of utilizing advertising techniques in the medical setting should be explored. We suggest physicians can maintain their ethical duty to act in the patient's best interest, while simultaneously maintaining the principles of informed consent and utilizing advertising techniques based on human psychology to present treatment options.

Analyzing China's contributions to major dermatologic journals from the past 20 years.

BACKGROUND: Over the past 20 years, China has experienced an increased popularity of Western medicine. The impact of Western medicine in China on the field of dermatology is not well characterized. OBJECTIVE: To assess the impact China has had on the field of dermatology by analyzing the total publications to six dermatological journals, compared to two other Asian countries: Japan and Korea. METHODS: PubMed was utilized to search for publications from China, Japan, and Korea within the past 20 years. Descriptive statistics were used to determine the average percentage change in publications during this 20-year period, and the average annual increase in total number of publications from each country. Comparisons were made using one-way ANOVA and two-group t-tests. RESULTS: From 1998 to 2019, there was a 24% average annual increase in publications from China (M=24.4, SD=24.5), compared to a 6% increase from Japan (M=5.6, SD=25.4, P=0.02) and 8% increase from Korea (M=7.8, SD=23.4, P=0.03). CONCLUSION: For the past 20 years, there has been a strong positive trend regarding the total number of publications from China. This finding might be related in part to an increased acceptance of Western medicine, which follows a similar trend during the time period we analyzed.

Publication rates on the topic of racial and ethnic diversity in dermatology versus other specialties.

BACKGROUND: The population of the U.S. is becoming more diverse every year. The field of dermatology is not following the same trend. OBJECTIVE: To assess the promotion of diversity in the field of dermatology by analyzing publications focused on diversity, compared to other specialties. METHODS: The PubMed database was systematically searched to identify publications focused on diversity from January 2008 to July 2019. The search criteria were as follows: dermatology/radiology/ophthalmology/ anesthesiology/orthopedic surgery/family medicine/ internal medicine/general surgery AND diversity/ diverse/racial/race/ethnic/ethnicity/cultural/culture/competency/competence. Comparisons were made using single-factor ANOVA and two-group t-tests. A qualitative analysis was performed for publications in the field of dermatology. RESULTS: From January 2016 to July 2019, there were 25 publications focused on diversity in dermatology (Mean=6.25, SD=2.06), compared to 6 in radiology (Mean=1.50, SD=1.29, P=0.01), two in ophthalmology (Mean=0.50, SD=0.58, P=0.01), two in anesthesiology (Mean=0.50, SD=1.00, P=0.01), 12 in orthopedic surgery (Mean=3.00, SD=1.41, P=0.04), 23 in family medicine (Mean=5.75, SD=2.22, P=0.75), 9 in internal medicine (Mean=2.25, SD=1.71, P=0.02), and 7 in general surgery (Mean=1.75, SD=0.50, P=0.02). CONCLUSIONS: Although the field of dermatology has suffered from a lack of racial/ethnic diversity, efforts to promote diversity via increased publications in the last four years have been stronger in dermatology compared to many other fields.

Implementation of a fracture liaison service and its effects on osteoporosis treatment adherence and secondary fracture at a tertiary care academic health system.

In this retrospective study, approximately 77% of patients who attended their osteoporosis clinic follow-up appointments following a fragility fracture were started on medical treatment. Approximately 82% of those patients were adherent with their treatment, and 1% of patients sustained a secondary fragility fracture while on treatment. PURPOSE: To assess the effects of implementation of a fracture liaison service at a tertiary care academic medical center on osteoporosis treatment adherence and secondary fracture rates. METHODS: We retrospectively reviewed over 6000 patients age 50 years or greater during a 5-year time period (2013-2018). Patients were identified as having a fragility fracture on presentation to the emergency department at the Wake Forest Baptist Medical Center and referred to our osteoporosis clinic using the electronic medical record. Data were collected regarding those patients who were recommended treatment, started treatment, maintained adherent to treatment, and those who sustained a secondary fracture. RESULTS: 6178 patients were identified as having a fragility fracture and referred to the osteoporosis clinic. 2631 of these patients successfully had a scheduled outpatient appointment at the osteoporosis clinic, of which 1937 attended their initial appointment and 1840 of these patients were prescribed treatment. Of the 1840 patients who were initially prescribed medication, 1416 (76.96%) initiated their treatment, and 1156 (81.64%) remained adherent to treatment. Fifteen patients (1.05%) on treatment sustained a secondary fracture after initiation of therapy. CONCLUSION: Implementation of a fracture liaison service at a tertiary care academic medical center is feasible and is associated with high rates of treatment implementation/adherence and low incidence of secondary fracture.

Comparing psoriasis advertisement methods with patient willingness to initiate treatment.

Background: Many patients with psoriasis struggle with taking biologic agents. The way in which providers present medications could enhance treatment adherence.Objectives: To determine how fear appeals, personal appeals, and social appeals influence psoriasis patients' willingness to use a biologic.Methods: A randomized online survey study was used to assess subjects with a self-reported diagnosis of psoriasis and their willingness to initiate treatment. Subjects were randomized in a 1:1:1 ratio to receive an online survey with the following emotional appeals: social, fear, or personal (n = 315). Subject-reported willingness to take treatment was recorded on a 10-point Likert scale and analyzed via single-factor ANOVA, two-group t-tests, chi-squared analysis, and multiple linear regression analysis.Results: A total of 315 subjects with a reported diagnosis of psoriasis completed the survey. Patient demographic information includes the following: mean age of 35 years ± 11.2; 67% female. Compared to subjects presented with a social appeal (M = 6.2, SD = 2.9), subjects presented with a fear appeal (M = 7.1, SD = 2.5, p = .01) and personal appeal (M = 7.0, SD = 2.7, p = .03) reported a greater average willingness to take treatment.Conclusions: Presenting biologic agents using fear or personal appeals may be a simple and effective technique to improve patients' willingness to take treatment.