Improvement in the management of Psoriatic Arthritis (PsA)

188 Pages·2016·13.04 MB·English

Improvement in the
management of
Psoriatic Arthritis
Summer 2016
GBL/HUD/0616/0720
Executive
summary
This study was commissioned and solely funded by AbbVie
Home
AbbVie had no role in the conduct of the study, collection, management, analysis and
interpretation of data, or preparation of this report
Key
findings
© 2016 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independent firms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind
KPMG International or any other member firm third parties, nor does KPMG International have any such authority to obligate or bind any member firm. Al rights reserved. 1
GBL/HUD/0616/0720
Executive Findings
1 5
summary Page 24
Page 4
Detailed site
Contents Context
2 6 specifications
Page 12
Page 125
Goals Appendix
34 7
Page 18 Page 177
Approach Home
4
Page 20
Key
findings
© 2016 KPMMGG IInntteerrnnaattioionnaal lC Cooooppeeraratitvivee ( '(K'KPPMMGG In Itnetrenrantaiotinoanl'a),l' a), Sa wSiwssis esn etintyti.t My. eMmebmerb efirm fisrm osf tohfe t hKeP MKPGM nGet wneotrwk oorfk i nodfe inpdeendpentdenftirms are affiliated with KPMG
©
KP 2M01G6 I nKtPeMrnGat iIonntearl noar taionnya ol tChoeor pmereamtivbe r( “fiKrmPM thGir dIn ptearntiaetsio, naolr” )d,o ae Ssw KiPsMs eGn tInipItntyae.t reMntriaentmisao,ntb inaeolro nh frai rvdlm.e osK ae oPnsfyM tKshuGPec MKhInP aGMtuet GIhrno ntraeityriwo ntonoa rtaokilbo olpnifg raiaonltd vehe iodaprvebnesidn anedn oaty nfc yisrl mimuescne mhta r bseae uar ftfvfhiriliomcaert.ei stAdy.l l w Ntrioigto ho tmKsb PlreieMgmsaGetbr veIene trdoe .rfrn irbamitnio dhn al.sn K yaP nMmyG ea mIuntbeheronrra itftioyrnm taol. pAorobllv lridgigeasht etnso o rcrel iebsneintr dsve eKrvdPi.cMesG. N Ion mtreneamtiboenr afilr mo rh asn yan oy tahuethr omritey mto boeblrig faitrem o rt hbinrd 2
GBL/HUD/0616/0720
How to navigate through the report
NFaivnidgiantgiosn
Executive Summary Context Goals
Pages 4–11 Pages 12 –17 Pages 18–19
Summary of the context, goals, approach Disease background, epidemiology, clinical Details on the aims and objectives
and key findings from the report and economic burden of the project
Approach Findings Detailed site specifications
Pages 20–23 Pages 24–124 Pages 125–176
Information on how the research Compilation on the project findings, Detailed information on the visited
was conducted and who was including the patient pathway in PsA, key centres, including the overview of
involved challenges and interventions to help the teams, their key strengths and
address them challenges faced
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Key
findings
©
KP 2M01G6 I nKtPeMrnGat iIonntearl noar taionnya ol tChoeor pmereamtivbe r( “fiKrmPM thGir dIn ptearntiaetsio, naolr” )d,o ae Ssw KiPsMs eGn tInittye. rMnaetmionbaelr h fairvmes a onfy tshuec KhP aMutGho nreittyw to rokb olifg iantdee oprebnidnedn atnfyir mse marbee ar ffirlimat.e Adl lw rigth tKs PreMsGer vInetde.rnational. KPMG International provides no client services. No member firm has any authority to obligate or bind 3
GBL/HUD/0616/0720
Executive
summary
Home
Key
findings
©
KP 2M01G6 I nKtPeMrnGat iIonntearl noar taionnya ol tChoeor pmereamtivbe r( “fiKrmPM thGir dIn ptearntiaetsio, naolr” )d,o ae Ssw KiPsMs eGn tInittye. rMnaetmionbaelr h fairvmes a onfy tshuec KhP aMutGho nreittyw to rokb olifg iantdee oprebnidnedn atnfyir mse marbee ar ffirlimat.e Adl lw rigth tKs PreMsGer vInetde.rnational. KPMG International provides no client services. No member firm has any authority to obligate or bind 4
GBL/HUD/0616/0720
Executive summary (1/7)
Executive
summary
Psoriatic Arthritis PsA is characterised AbbVie sponsored
(PsA) is a form of by a varied clinical course KPMG to produce an
chronic inflammatory arthritis but can lead to progressive joint independent report on PsA care
associated with psoriasis, destruction, disability and in collaboration with the Group
a skin condition characterised impaired quality of life. In addition, for Research and Assessment
skinb. yP sreAd ,o fclackuyr sp iantc ahpepsr onx itmhea tely paritsiekn otfs aw nituhm PbIsneAdr eaoprfe ec naodtm eanont r ibrneicdproeitraitesse,d Arthorfit iPss (oGriRasAisP PaAnd) wPsitohr itahteic aim
30% of patients with psoriasis including diabetes, metabolic of improving the quality and
and develops on average 10 syndrome, depression efficiency of care for PsA
years
o fa pftseorr itahseis o 1nset and dcaisredaiosveass 2cular patients globally
AbbVie
Context
Over the last decade, Goals
the management of PsA has By doing so, we aimed to
been improved by the introduction identify, document and share The goal of this
of new treatment options. practices to help increase the project was to collate
However, a number of awareness of PsA, promote information and views on key
unKmePt nMeedGs in PsA care remain, timely and accurate diagnosis, initiatives to improve care
which place a significant clinical, increase the consistency of care from clinicians and Home
social and economic burden on and, ultimately, improve patients in multiple
patients, their families outcomes for patients worldwide centres
and society with PsA
GRAPPA fKinedyi ngs
Sources: 1: Gladman, D.D. et al (2005) Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 64:ii14–ii17; 2: Ogdie, A., et al (2015) Recognizing and managing comorbidities
in psoriatic arthritis. Curr Opin Rheumatol. 27(2):118 -26
©
KP 2M01G6 I nKtPeMrnGat iIonntearl noar taionnya ol tChoeor pmereamtivbe r( “fiKrmPM thGir dIn ptearntiaetsio, naolr” )d,o ae Ssw KiPsMs eGn tInittye. rMnaetmionbaelr h fairvmes a onfy tshuec KhP aMutGho nreittyw to rokb olifg iantdee oprebnidnedn atnfyir mse marbee ar ffirlimat.e Adl lw rigth tKs PreMsGer vInetde.rnational. KPMG International provides no client services. No member firm has any authority to obligate or bind 5
GBL/HUD/0616/0720
Executive summary (2/7)
Executive
summary
Click on each row of the table below to go to the relevant site specific section
GRAPPA selected
7 centres around
the world to participate
in this project. They were
picked to represent a variety
of geographies, healthcare
systems, care settings Centre Location
and different
Findings were
access to specialties Boston, US
collated into the
following report which Whenever possible, Note: We also interviewed a dermatologist-rheumatologist from the Tufts Medical Center in Boston
nearby community centres
was then reviewed by the
were included to understand
participating centres as well
the challenges in PsA Toronto, Canada
as members of GRAPPA
care within this Note: We also interviewed a rheumatologist from the Women’s College Hospital in Canada
to ensure the validity of
particular ecosystem
the findings
presented Lübeck, Germany
Buenos Aires, Argentina
A group of
KPMG gathered Approach ex–scientists and
ex–clinicians from KPMG
stakeholders’ views on
five key areas: challenges in visited these centres and London, UK
engaged with a range of
PsA care, interventions
stakeholders including
likely to address them,
ne
ctwenotrkicsi,t yp atniedn t– rd
nheuerumsmeasat,to oplolaogtgiesistntsts,s, CGaropoet eT oSwchnuur Hospital Cape Town, South Africa Home
benefit creation
and patient
organisations The Prince of Wales Hong Kong, China
Hospital, Hong Kong
Key
findings
©
KP 2M01G6 I nKtPeMrnGat iIonntearl noar taionnya ol tChoeor pmereamtivbe r( “fiKrmPM thGir dIn ptearntiaetsio, naolr” )d,o ae Ssw KiPsMs eGn tInittye. rMnaetmionbaelr h fairvmes a onfy tshuec KhP aMutGho nreittyw to rokb olifg iantdee oprebnidnedn atnfyir mse marbee ar ffirlimat.e Adl lw rigth tKs PreMsGer vInetde.rnational. KPMG International provides no client services. No member firm has any authority to obligate or bind 6
GBL/HUD/0616/0720
Executive summary (3/7)
Executive
summary
Key findings (1/5):
— Following the discussions with specialists and patients, the patient pathway in PsA was divided into four phases: 1. Pre–diagnosis, 2. Referral and
diagnosis, 3. Treatment initiation and management and 4. Follow–up
— Challenges: The stakeholders identified a number of challenges that persist along the patient pathway. Limited awareness of PsA among non–
rheumatologists was recognised as a challenge by all the visited centres (100%) followed by a siloed approach to care (86%), late referral and
diagnosis (71%) and an inadequate management of comorbidities (57%)
Pre–diagnosis Referral and Treatment initiation Follow–up
diagnosis and management
— Limited of — Lack of screening — Siloed approach to — Inadequate
awareness of care in secondary, management of
PsA among HCPs tertiary and comorbidities
and patients community centres
— Delayed referrals — Gaps in clinical — Lack of regular
management follow–up
Home
— Challenges with — Challenges
differential diagnosis associated with the
use of biologics
Key
findings
— Lack of patient
Click on each small circle to go to the relevant ‘challenge’ centricity
Source: KPMG interviews
©
KP 2M01G6 I nKtPeMrnGat iIonntearl noar taionnya ol tChoeor pmereamtivbe r( “fiKrmPM thGir dIn ptearntiaetsio, naolr” )d,o ae Ssw KiPsMs eGn tInittye. rMnaetmionbaelr h fairvmes a onfy tshuec KhP aMutGho nreittyw to rokb olifg iantdee oprebnidnedn atnfyir mse marbee ar ffirlimat.e Adl lw rigth tKs PreMsGer vInetde.rnational. KPMG International provides no client services. No member firm has any authority to obligate or bind 7
GBL/HUD/0616/0720
Executive summary (4/7)
Executive
summary
Click on each small circle to go to the relevant ‘challenge’
Key findings (2/5): Click on flag row to go to the relevant case study
— Interventions: During the centre visits we identified 24 solutions to improve care across the different phases of the patient pathway. These are further
supported by 29 detailed case studies which provide detailed descriptions of how the visited centres have implemented them
Limited awareness of PsA
among HCPs and patients
Many clinicians are not aware of the risk
of musculoskeletal disease in patients
with psoriasis
— Education of GPs and dermatologists
1. As easy as 'PSA'
2. Peer education
— Education of patients with psoriasis
3. Patient and peer education
Pre–diagnosis
Lack of screening Delayed referral to a Challenges with differential
There is a lack of regular rheumatologist diagnosis
screening among patients Patients are often referred to a Following a referral, diagnosis of PsA
with psoriasis rheumatologists several years can remain challenging even to
after symptom onset experienced rheumatologists
— Regular screening — Early referral — Consistent assessment criteria
Home
— Refinement and/or development of 7. Referral forms for GPs — Interdisciplinary approach
new screening tools 8. Self-referral scheme — Use of diagnostic equipment
4. PASE 9. Outreach activities 11. Radiologists–ultrasonographers
R
defiaegrrnaol sainsd 5. ToPAS — Networks and referral pathways fKinedyi ngs
6. PEST 10. Hospital network
Note: The flags represent the country of the centre in which the intervention was observed
Source: KPMG interviews
©
KP 2M01G6 I nKtPeMrnGat iIonntearl noar taionnya ol tChoeor pmereamtivbe r( “fiKrmPM thGir dIn ptearntiaetsio, naolr” )d,o ae Ssw KiPsMs eGn tInittye. rMnaetmionbaelr h fairvmes a onfy tshuec KhP aMutGho nreittyw to rokb olifg iantdee oprebnidnedn atnfyir mse marbee ar ffirlimat.e Adl lw rigth tKs PreMsGer vInetde.rnational. KPMG International provides no client services. No member firm has any authority to obligate or bind 8
GBL/HUD/0616/0720
Executive summary (5/7)
Executive
summary
Click on each small circle to go to the relevant ‘challenge’
Key findings (3/5): Click on flag to go to the relevant case study
— Interventions: During the centre visits we identified 24 solutions to improve care across the different phases of the patient pathway. Theseare further
supported by 29 detailed case studies which provide detailed descriptions of how the visited centres have implemented them
Siloed approach to care in secondary, Challenges associated with the use of biologics
tertiary and community centres Many effective treatment options are available for PsA;
Although PsA affects both joints and skin, there is however, access to these therapies can be reduced or delayed
often little coordination of care between different for some patients, especially in lower–income areas
specialties, especially in community–based clinics
— Improved coordination of dermatology and — Enrolment of patients into clinical trials
rheumatology services 20. PsA research clinic
12. – 16. Combined clinics — Development of relationships with commissioners
17. Multidisciplinary care
— Development of networks and relationship between
community–based centres
18. The Arthritis Programme
19. Developing relationships between HCPs
TrePartem–deinatg inoitsiaistion Gaps in clinical management Lack of patient centricity
and management Although many effective PsA therapies have been As patients become more engaged in healthcare, they
introduced over the last decade, many patients do want to be empowered to manage their own health.
not respond to their treatment or may lose the However, many centres could do more to be truly patient–
initial response over time centric
Home
— Use of protocols and treatment algorithms — Improved communication between HCPs and patients and
— Development and validation of new outcome engagement of patients in their care
measures in PsA 21. Pregnancy clinics
Key
— Development of educational programmes for patients findings
22. Patient centricity
Note: The flags represent the country of the centre in which the intervention was observed — Patient education by the medical office staff
Source: KPMG interviews — Collaboration with patient associations
©
KP 2M01G6 I nKtPeMrnGat iIonntearl noar taionnya ol tChoeor pmereamtivbe r( “fiKrmPM thGir dIn ptearntiaetsio, naolr” )d,o ae Ssw KiPsMs eGn tInittye. rMnaetmionbaelr h fairvmes a onfy tshuec KhP aMutGho nreittyw to rokb olifg iantdee oprebnidnedn atnfyir mse marbee ar ffirlimat.e Adl lw rigth tKs PreMsGer vInetde.rnational. KPMG International provides no client services. No member firm has any authority to obligate or bind 9
GBL/HUD/0616/0720