Improvement in the Management of Psoriatic Arthritis

188 Pages·2016·15.34 MB·English

Improvement in the
management of
Psoriatic Arthritis
Summer 2016
GBL/HUD/0616/0720
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Executive
summary
This study was commissioned and solely funded by AbbVie
AbbVie had no role in the conduct of the study, collection, management, analysis and
interpretation of data, or preparation of this report
© 2016 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independentfirms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind 1
KPMG International or any other member firm third parties, nor does KPMG International have any such authority to obligate orbind any member firm. All rights reserved.
GBL/HUD/0616/0720
HHoommee
Executive Findings
1 5
summary Page 24
Page 4
Contents
Detailed site
Context
2 6 specifications
Page 12
Page 125
Goals Appendix
43 7
Page 18 Page 177
Approach
4
Page 20
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GBL/HUD/0616/0720
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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
© 2016 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independentfirms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind 3
KPMG International or any other member firm third parties, nor does KPMG International have any such authority to obligate orbind any member firm. All rights reserved.
GBL/HUD/0616/0720
HHoommee
Executive
summary
© 2016 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independentfirms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind 4
KPMG International or any other member firm third parties, nor does KPMG International have any such authority to obligate orbind any member firm. All rights reserved.
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Executive summary (1/7)
Executive
summary
Psoriatic Arthritis PsA is characterised
AbbViesponsored
(PsA) is a form of by a varied clinical course
KPMGto produce an
chronic inflammatory arthritis but can lead to progressivejoint
independent reporton PsA care
associated with psoriasis, destruction, disabilityand
in collaboration with the Group
a skin condition characterised impaired qualityof life. In addition,
for Research and Assessment
by red, flaky patches on the patients with PsA are at an increased
of Psoriasis and Psoriatic
skin. PsA occurs in approximately risk of a number of comorbidities,
Arthritis (GRAPPA) with the 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 after the onset and cardiovascular
patients globally
of psoriasis 1 diseases 2
Independent report
AbbVie
KPMG
GRAPPA
Context
Goals
Over the last decade,
By doing so, we aimed to
the management of PsA has
identify, document and share The goal of this
been improved by the introduction
practices to help increase the project was to collate
of new treatment options.
awareness of PsA, promote information andviews on key
However, a number of
timely and accurate diagnosis, initiatives to improve care
unmet needs in PsA care remain,
increase the consistency of care from clinicians and
which place a significant clinical,
and, ultimately, improve patients in multiple
social and economic burden on
outcomes for patients worldwide centres
patients, their families
with PsA
and society
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
© 2016 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independentfirms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind 5
KPMG International or any other member firm third parties, nor does KPMG International have any such authority to obligate orbind any member firm. All rights reserved.
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Executive summary (2/7)
Executive
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GRAPPAselected
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
Whenever possible,
following report which Note: We also interviewed a dermatologist-rheumatologist from the Tufts Medical Center in Boston
nearby community centres
was then reviewed bythe
were included to understand
participating centresas well Toronto, Canada
the challenges in PsA
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
Lübeck, Germany
presented
Buenos Aires, Argentina
A group of
Approach ex-scientists and
KPMG gathered
ex-clinicians from KPMG
stakeholders’ views on
visited these centres and London, UK
five key areas: challenges in
engaged with a range of
PsA care, interventions
stakeholdersincluding
likely to address them,
rheumatologists,
networks, patient- Groote Schuur Hospital Cape Town,South Africa
dermatologists,
centricity and Cape Town
nurses, patients
benefit creation
and patient
organisations The Prince of Wales Hong Kong, China
Hospital, Hong Kong
© 2016 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independentfirms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind 6
KPMG International or any other member firm third parties, nor does KPMG International have any such authority to obligate orbind any member firm. All rights reserved.
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Executive summary (3/7)
Executive
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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%)
TThhiiss iimmaaggee ccaannnnoott ccuurrrreennttllyy bbee ddiissppllaayyeedd..
Pre-diagnosis Referral and Treatment initiation Follow-up
diagnosis and management
— Limited — Lack of screening — Siloed approach to
— Inadequate
awareness of PsA care in secondary,
treatment of
among HCPs and tertiary and
comorbidities
patients community centres
— Delayed referrals — Gaps in clinical — Lack of regular
management follow-up
— Challenges with — Challenges
differential diagnosis associated with the
use of biologics
— Lack of patient-
centricity
Source: KPMG interviews
© 2016 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independentfirms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind 7
KPMG International or any other member firm third parties, nor does KPMG International have any such authority to obligate orbind any member firm. All rights reserved.
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Executive summary (4/7)
Executive
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Key findings (2/5):
— 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
rheumatologist diagnosis
There is a lack of regular
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
— 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
Referral and
5. ToPAS — Networks and referral pathways
diagnosis
6. PEST
10. Hospital network
Note: The flags represent the country of the centre in which the intervention was observed
Source: KPMG interviews
© 2016 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independentfirms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind 8
KPMG International or any other member firm third parties, nor does KPMG International have any such authority to obligate orbind any member firm. All rights reserved.
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Executive summary (5/7)
Executive
summary
Key findings (3/5):
— 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
Gaps in clinical management Lack of patient centricity
TrePartem-deinatg innoitsiiastion
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
— Use of protocols and treatment algorithms — Improved communication between HCPsand patients and
engagement of patients in their care
— Development and validation of new outcome
measures in PsA 21. Pregnancy clinics
— Development of educational programmes for patients
22. Patient centricity
— Patient education by the medical office staff
Note: The flags represent the country of the centre in which the intervention was observed
Source: KPMG interviews — Collaboration with patient associations
© 2016 KPMG International Cooperative (“KPMG International”), a Swiss entity. Member firms of the KPMG network of independentfirms are affiliated with KPMG International. KPMG International provides no client services. No member firm has any authority to obligate or bind 9
KPMG International or any other member firm third parties, nor does KPMG International have any such authority to obligate orbind any member firm. All rights reserved.
GBL/HUD/0616/0720