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Identifying and managing psoriasis-associated comorbidities: the IMPACT research programme

Cordingley, Lis; Nelson, Pauline A; Davies, Linda; Ashcroft, Darren; Bundy, Christine; Chew-Graham, Carolyn; Chisholm, Anna; Elvidge, Jamie; Hamilton, Matthew; Hilton, Rachel; Kane, Karen; Keyworth, Christopher; Littlewood, Alison; Lovell, Karina; Lunt, Mark; McAteer, Helen; Ntais, Dionysios; Parisi, Rosa; Pearce, Christina; Rutter, Martin; Symmons, Deborah; Young, Helen; Griffiths, Christopher EM

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Lis Cordingley

Pauline A Nelson

Linda Davies

Darren Ashcroft

Christine Bundy

Anna Chisholm

Jamie Elvidge

Matthew Hamilton

Rachel Hilton

Karen Kane

Christopher Keyworth

Alison Littlewood

Karina Lovell

Mark Lunt

Helen McAteer

Dionysios Ntais

Rosa Parisi

Christina Pearce

Martin Rutter

Deborah Symmons

Helen Young

Christopher EM Griffiths


BackgroundPsoriasis is a common, lifelong inflammatory skin disease, the severity of which can range from limited disease involving a small body surface area to extensive skin involvement. It is associated with high levels of physical and psychosocial disability and a range of comorbidities, including cardiovascular disease, and it is currently incurable.ObjectivesTo (1) confirm which patients with psoriasis are at highest risk of developing additional long-term conditions and identify service use and costs to patient, (2) apply knowledge about risk of comorbid disease to the development of targeted screening services to reduce risk of further disease, (3) learn how patients with psoriasis cope with their condition and about their views of service provision, (4) identify the barriers to provision of best care for patients with psoriasis and (5) develop patient self-management resources and staff training packages to improve the lives of people with psoriasis.DesignMixed methods including two systematic reviews, one population cohort study, one primary care screening study, one discrete choice study, four qualitative studies and three mixed-methodology studies.SettingPrimary care, secondary care and online surveys.ParticipantsPeople with psoriasis and health-care professionals who manage patients with psoriasis.ResultsPrevalence rates for psoriasis vary by geographical location. Incidence in the UK was estimated to be between 1.30% and 2.60%. Knowledge about the cost-effectiveness of therapies is limited because high-quality clinical comparisons of interventions have not been done or involve short-term follow-up. After adjusting for known cardiovascular risk factors, psoriasis (including severe forms) was not found to be an independent risk factor for major cardiovascular events; however, co-occurrence of inflammatory arthritis was a risk factor. Traditional risk factors were high in patients with psoriasis. Large numbers of patients with suboptimal management of known risk factors were found by screening patients in primary care. Risk information was seldom discussed with patients as part of screening consultations, meaning that a traditional screening approach may not be effective in reducing comorbidities associated with psoriasis. Gaps in training of health-care practitioners to manage psoriasis effectively were identified, including knowledge about risk factors for comorbidities and methods of facilitating behavioural change. Theory-based, high-design-quality patient materials broadened patient understanding of psoriasis and self-management. A 1-day training course based on motivational interviewing principles was effective in increasing practitioner knowledge and changing consultation styles. The primary economic analysis indicated a high level of uncertainty. Sensitivity analysis indicated some situations when the interventions may be cost-effective. The interventions need to be assessed for long-term (cost-)effectiveness.LimitationsThe duration of patient follow-up in the study of cardiovascular disease was relatively short; as a result, future studies with longer follow-up are recommended.ConclusionsRecognition of the nature of the psoriasis and its impact, knowledge of best practice and guideline use are all limited in those most likely to provide care for the majority of patients. Patients and practitioners are likely to benefit from the provision of appropriate support and/or training that broadens understanding of psoriasis as a complex condition and incorporates support for appropriate health behaviour change. Both interventions were feasible and acceptable to patients and practitioners. Cost-effectiveness remains to be explored.Future workPatient support materials have been created for patients and NHS providers. A 1-day training programme with training materials for dermatologists, specialist nurses and primary care practitioners has been designed. Spin-off research projects include a national study of responses to psoriasis therapy and a global study of the prevalence and incidence of psoriasis. A new clinical service is being developed locally based on the key findings of the Identification and Management of Psoriasis Associated ComorbidiTy (IMPACT) programme.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 10, No. 3. See the NIHR Journals Library website for further project information.


Cordingley, L., Nelson, P. A., Davies, L., Ashcroft, D., Bundy, C., Chew-Graham, C., …Griffiths, C. E. (2022). Identifying and managing psoriasis-associated comorbidities: the IMPACT research programme. Programme Grants for Applied Research, 10(3), 1-240.

Journal Article Type Article
Acceptance Date Mar 1, 2022
Online Publication Date Aug 25, 2023
Publication Date Mar 1, 2022
Journal Programme Grants for Applied Research
Print ISSN 2050-4322
Publisher NIHR Journals Library
Volume 10
Issue 3
Pages 1-240
Keywords Public Health, Environmental and Occupational Health, Health Informatics, Health Policy
Publisher URL


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