Managing the higher-touch patient with psoriasis: The value of consistent clinical engagement

In this episode of Topical Conversations, Dawn Merritt, DO, and Neal Bhatia, MD, discuss the management of patients with psoriasis who benefit from a higher-touch approach to care. Their conversation extends beyond selecting an effective biologic to examine how ongoing clinical engagement can support adherence, identify barriers to treatment, and provide opportunities to address the broader health concerns. The speakers also explore how health care professional (HCP)-administered biologics can facilitate regular patient contact and reinforce long-term treatment success.

Identifying patients who benefit from closer follow-up

Dr Bhatia describes the "higher-touch patient" as someone who requires more frequent engagement to remain connected to treatment and achieve the best possible long-term outcomes. Rather than focusing solely on prescribing therapy, he emphasizes understanding where patients are in their treatment journey, discussing their goals, and helping them navigate the lifestyle changes that often accompany psoriasis management.

These patients are not defined solely by disease severity. As clinicians develop long-term relationships with their patients, they often recognize social or logistical challenges that can interfere with treatment adherence. Dr Merritt describes a college student whose living situation made storing and self-administering a biologic both impractical and uncomfortable. Transitioning to an in-office administered biologic provided structured follow-up visits that helped keep the patient engaged with treatment.

Dr Bhatia highlights similar situations among military personnel, who may face practical barriers to storing injectable medications or concerns about administering injections in shared living environments. For these patients, in-office administration can improve adherence while giving clinicians greater confidence that treatment is being received as intended.

Regular touchpoints create opportunities beyond skin clearance

Both speakers emphasize that scheduled office visits provide opportunities to evaluate much more than psoriasis severity. Dr Bhatia explains that seeing patients regularly allows clinicians to identify factors that may be limiting treatment response, including smoking, obesity, or other lifestyle influences that may not be apparent during less frequent follow-up.

These visits also create opportunities to manage persistent symptoms while patients are working toward maximal biologic efficacy. Ongoing assessment of itch, scalp involvement, nail disease, joint symptoms, and oral manifestations allows clinicians to address residual disease, optimize supportive therapies, and better understand how psoriasis is affecting patients' daily lives, including their ability to exercise, work, and maintain overall health.

Seeing the whole patient

Dr Merritt highlights the unique value of regular office visits among Medicare patients, many of whom appreciate returning every 12 weeks for treatment and develop strong relationships with the clinical staff. These encounters often reveal important health or social concerns that might otherwise go unnoticed.

She recalls caring for an older patient whose psoriasis remained well controlled but who appeared withdrawn following the recent loss of his wife. During his treatment visit, she recognized signs that he was struggling with nutrition and self-care, ultimately reaching out to family members to help ensure he received additional support beyond dermatologic treatment.

Dr Bhatia agrees that subtle changes in a patient's appearance, behavior, or overall well-being are often easier to recognize during in-person visits. He also notes that the broader clinical team can play an important role in identifying concerns that warrant further attention. For patients with metabolic syndrome or elevated cardiovascular risk, these regular encounters provide additional opportunities to remain engaged with their overall health, not just their skin disease.

Persistence and adherence with HCP-administered biologics

Dr Merritt also discusses real-world evidence suggesting strong treatment persistence with IL-23 inhibitors.

While persistence is influenced by multiple factors, both speakers suggest that HCP-administered biologics may contribute by reducing some of the logistical barriers associated with self-administration. For patients who struggle with medication storage, scheduling doses, or treatment adherence, regular in-office administration provides consistent accountability while allowing clinicians to monitor progress throughout therapy.

Integrating higher-touch care into a busy practice

Providing individualized care does not necessarily require disrupting clinic efficiency. Dr Bhatia explains that thoughtful scheduling can help match visit length to patient needs. Patients who are stable and doing well may be scheduled early in the day for streamlined appointments, while retirees or patients requiring more extensive discussion may benefit from appointment times that allow for greater flexibility.

He also encourages practices to consider travel time, work schedules, and other patient commitments when coordinating visits. These logistical considerations can improve patient satisfaction while maintaining efficient clinic flow.

Dr Merritt adds that patients with a history of poor adherence may particularly benefit from the structure provided by regular office visits. For individuals who struggle with remembering to obtain, store, or administer medications, closer clinical follow-up can reduce treatment interruptions and improve long-term disease control.

Dr Bhatia concludes by noting that many dermatologists have experienced the frustration of seeing patients return after prolonged gaps in care with uncontrolled psoriasis because treatment was never initiated or maintained. Incorporating office-based therapies when appropriate allows clinicians to maintain closer engagement with selected patients and may improve both adherence and overall outcomes.