Family doctors roped in to treat mild cases of psoriasis

SINGAPORE - Salesman Tan Soo Chor (above), 56, used to have to take a 15-minute drive to the National Skin Centre (NSC) whenever he had an outbreak of psoriasis.

But under a new programme by the skin centre, he can just go to a family doctor in Yio Cho Kang, less than five minutes away.

"It's more convenient," said the father of four, who lives in a five-room flat in Sengkang. He was diagnosed with psoriasis three years ago and had an outbreak on his scalp in March.

Under the pilot programme, a patient with minor psoriasis can now visit a participating family doctor near his own home to review his condition and replenish his medication, instead of having to make his way to the skin centre in Mandalay Road every three to six months.

He will need to pay the family doctor a consultation fee, but the cost of the medication is the same as what he would pay at the skin centre.

The family doctor will fax the medication order to the skin centre and the medication will be couriered - free of charge - over to patient's home in a couple of days.

Prior to the delivery, the pharmacist will usually call the patient to confirm the delivery. If the patient prefers to pay by card, this can be processed. Or he can pay the courier cash upon delivery.

Medication often make up the bulk of the cost for patients, said Dr Colin Theng, a senior consultant at the NSC, who is heading the programme.

The programme, called the Psoriasis Right Siting Management Programme (Prism), was launched in May last year.

Since then, eight family doctors and 26patients have enrolled in the programme.

Acknowledging that the numbers are small, Dr Theng said one hurdle in trying to get more patients to join is the perception that the level of care is better at specialist centres than at family clinics.

But he said family doctors who take part in the programme will hold a graduate diploma in family practice dermatology and there is a sizeable pool of these doctors around. Patients also have to ensure their condition is well-controlled on topical medication.

He said the programme is not meant for patients on oral medicine, as such medication may damage the liver and kidney and these patients are best monitored at a specialist centre, where they undergo blood tests regularly to test for damage.

Nonetheless, the programme benefits not just patients with mild psoriasis, it also frees doctors at NSC to see the more serious cases, said Dr Theng.

He said a study is under way to monitor patients' satisfaction with the programme. The results are not available yet.

The skin centre has seen an increase in the number of psoriasis patients over the last three years, from 1,842 in 2009 to 2,174 last year.

This could be due to better awareness of the condition, said Dr Theng.

The skin centre now runs four half-day clinics for psoriasis patients every week. This is the first time that doctors at the NSC are working with family doctors to manage a skin condition.

If successful, it may be rolled out to more family doctors trained in dermatology and include other chronic skin conditions such as eczema. Eczema also causes red itchy patches on the skin but, unlike psoriasis, it is thought to be a response to environmental allergies or irritants.

Mr Tan has seen the family doctor just once since his last outbreak in March and everything has gone on smoothly since then. He also said it was good that the cost of the medication has remained the same.


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