British Journal of Dermatology | 2021
PS03 (P39): Real‐world disease characteristics and treatment patterns in patients with atopic dermatitis in the UK: results from the Atopic Dermatitis Patient Satisfaction and Unmet Need Survey
Abstract
PS01 Psychodermatology: challenges faced by UK dermatologists J. Callander, D.S. Alsaadi, O. Azamfirei, P. Lepping and P.D. Yesudian Wrexham Maelor Hospital, Wrexham, UK; Ysbyty Glan Clwyd, Bodelwyddan, UK; and Ysbyty Gwynedd, Bangor, UK Psychodermatological diseases form an under-recognized but significant aspect of work in dermatology. We sent a survey to all members of the British Association of Dermatologists and UK Staff/Associate Specialist database members to gain understanding of their confidence, training and difficulties in looking after patients with psychodermatological conditions. Fifty dermatologists responded to the survey. Thirty-four (68%) were female. The experience of responders ranged from < 5 years to > 30 years of dermatology practice. Most (n = 32; 64%) had > 10 years’ experience. Dermatologists from every UK region were represented. Three (6%) worked in dedicated psychodermatology clinics. Respondents reported feeling confident ‘most of the time’ (n = 24; 48%) or ‘about 50% of the time’ (n = 19; 38%) in diagnosing psychodermatological conditions. Less confidence was expressed in management of these diseases, with only 12 (24%) feeling confident ‘most of the time’ and 17 (34%) feeling confident ‘rarely’. Thirty-six (72%) felt that their training in psychodermatology was insufficient. The majority (n = 42; 84%) of clinicians reported ‘rarely’ or ‘never’ feeling confident in prescribing antipsychotics for patients with delusional infestation. Specific comments included feeling inadequately trained, suggesting another speciality such as psychiatry or primary care should prescribe them, and concern about the risk of cardiac toxicity (prolonged QT interval). In terms of clinic time allocated for psychodermatology patients, the most frequent answer was 20 min (n = 22; 44%), followed by 10 min (n = 14; 28%). Many responders commented that they had inadequate time for these patients. Thirty-five (70%) disagreed or strongly disagreed that psychodermatology conditions could be diagnosed and managed effectively via virtual/telephone clinics. There was a varied response as to whether psychodermatology patients were reviewed in a multiconsultant clinic: rarely (n = 15; 30%); most of the time (n = 14; 28%), 50% of the time (n = 11; 22%); never (n = 9; 18%); always (n = 1; 2%). Dermatologists were asked to rank seven potential alterations to their normal clinic that they would find most beneficial to managing psychodermatology patients. Additional time in clinic, clinical psychologist input and referral to a specialist clinic were ranked first, second and third, with weighted scores of 214, 200 and 199, respectively. Our results showed a lack of confidence in UK dermatologists in the management of psychodermatological conditions, a finding that correlates with surveys of dermatologists in Canada and the USA. In our survey, lack of sufficient allocated time was identified as a particular challenge, which may impede effective management. Our survey also suggested a desire for further psychodermatology training among dermatologists of all levels of experience.