Nurse led strategies

Ms Elfie Deprez is a nurse specialist working at the dermatology department of the Ghent University Hospital. In this video she explains how they are using value-based healthcare to improve the care for patients with chronic skin conditions.

The feasibility of value-based healthcare in dermatology was first evaluated in patients with psoriasis. To this end, patient relevant outcomes are measured patients are screened for comorbidities and the costs to provide this care is calculated. Importantly, this care is organized in the context of an integrated practice unit (IPU) allowing a rapid referral of patients should certain comorbidities be detected. While this exercise provides a clear framework for value-based healthcare, it misses the voice of the patients. To address this, a set of interviews and workshops were organized with psoriasis patients and healthcare providers. These workshops learned that shared decision making is essential for patients. In this respect, patients indicated that is important for them to get information on all possible treatment options. Therefore, a decision aid was developed allowing nurse specialists to discuss the different options with patients and assess their treatment preference.

Following the successful implementation of value-based healthcare in the management of psoriasis patients, the dermatology department in the Ghent University Hospital is setting a up a similar framework for patients with hidradenitis suppurativa (HSPlus).

With the recognition of nurse specialists it is important to think about the potential of task shifting in dermatology. In fact, by shifting tasks from the dermatologist to the nurse specialist, you can reduce the workload for dermatologists which can in turn shorten waiting times for patients. In this light, the Ghent University Hospital has set up a nurse-led consultation for psoriasis patients with stable disease under treatment with a biological. In these consultations, nurse specialists can assess whether the patient is in fact still stable and look for potential comorbidities that require further attention. In addition to this, they can also help to streamline the administrative burden that comes with the use of biological agents in this setting. These nurse-led consultations are now held in between an annual visit with the dermatologist and the early experiences are very positive. In fact, patients even indicate that is often easier to discuss their concerns with a nurse specialist that with the dermatologist.