As attention to health literacy increases, recent research suggests that health literacy-related inequities may exist in psoriasis treatment. Addressing these inequalities requires meeting patients at their individual health literacy levels, using appropriate verbal, nonverbal, written, and graphic communications and, when necessary, kid gloves.
Health literacy is the extent to which patients can seek, understand, and use health-related information.1 In psoriasis, said Mark Lebwohl, MD, health literacy assumes particular importance because the development of multiple new, safe, highly effective treatments coincides with an avalanche of data regarding psoriasis comorbidities, the importance of which has not been fully appreciated by clinicians. Dr Lebwohl is the Waldman Professor and chairman, Kimberly and Eric J. Waldman Department of Dermatology at the Icahn School of Medicine at Mount Sinai in New York City.
Steven R. Feldman, MD, PhD, a professor of dermatology, pathology, and public health at Wake Forest University School of Medicine, Winston-Salem, North Carolina, credits an increasingly empowered society for increasing interest in health literacy. “The world has moved away from just listening to authority figures. The expectation is that patients should be adequately educated so they can play an active role in making good decisions and choosing their care.”
However, many patients with moderate to severe psoriasis who are at risk for heart attacks, psoriatic arthritis, and other comorbidities seem to settle for living with psoriasis, Dr Lebwohl said. “They’re not happy about it. But there are all kinds of barriers that interfere with their getting the best treatments. And unfortunately, even the information out there for those patients is often not accurate.”
For instance, patients with severe psoriasis who have Medicare Part D often get misleading information about the so-called doughnut hole, said Dr Lebwohl. Insurers tell them that their responsibility during this period is $3000 per month. “The patient thinks, ‘I can’t afford $36,000 a year.'” However, he said, insurers do not mention that the doughnut hole caps out at $6000, or that this figure includes the total of all their medicines. The doughnut hole also is shrinking, he added, so the amount patients will pay out of pocket is becoming even smaller. “The truth is, after the doughnut hole and any minor patient assistance programs, the cost to the patient is negligible.”
Patients who have heard warnings about infections and malignancy linked to older biologics often refuse safer new ones, Dr Lebwohl added. However, he said, drugs that block interleukin (IL)-17 (secukinumab and brodalumab) and IL-23 (guselkumab and tildrakizumab) are extremely effective and have not been linked to serious adverse events.
A study of 1275 Norwegian patients with psoriasis showed that these patients had lower Health Literacy Questionnaire scores than cohorts in other countries, which included patients with other chronic illnesses.2 Factors that correlated positively with health literacy included education, Dermatology Life Quality Index scores, and self-efficacy. Another study showed earlier access to biologics for patients with higher education and professional job titles.3