An exploratory study to investigate health-seeking behaviour in patients with psoriasis using framework analysis

Summary

Background

Psoriasis is a long-term inflammatory skin disorder, with negative effects on employment, relationships and social function frequently causing reduced quality of life. People with psoriasis often present to secondary care late into their condition but reasons for this are unknown.

Objectives

This observational study examines the patient pathway, health-seeking behaviour and drivers for referral to secondary care in patients with psoriasis.

Methods

Sixteen patients with mild to severe psoriasis, newly referred to secondary care participated in semi-structured interview. Scripts were analysed by thematic framework.

Results

The median duration of time living with psoriasis was 15 years at referral. Drivers of secondary care referral included: rapid deterioration or extremis, development of comorbidities, knowledge of treatment options and influence from partners and friends.

Reasons for late presentation to secondary care include familial experience of psoriasis, lack of follow-up following initiation of treatments in primary care, beliefs that psoriasis is incurable and must be tolerated and that psoriasis is not life threatening and therefore not worthy of medical help and difficulty in obtaining a secondary care referral. A common pathway from seeking help at psoriasis onset, evolving into the development of delayed health-seeking later in the pathway, was identified.

Conclusions

Identifying the causes of delay in presentation to secondary care and effective treatment ascertains key areas to target. Health-seeking early in the disease pathway provides a 'window of opportunity' for intervention, which may enable people with psoriasis to obtain early, effective treatment and achieve their full life potential.

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