August is Psoriasis Awareness Month. With over 3 million cases per year in the U.S., you probably know someone with psoriasis. To understand the inflammatory skin disease and learn more about treatment options, we sat down with Shane Berken, PharmD, about his experience treating GHC-SCW members with psoriasis and a cost-saving research study he conducted to help those that suffer from the disease.
What is psoriasis?
Psoriasis is a chronic, inflammatory skin disease that comes in multiple forms. The most common form is plaque psoriasis, which is characterized by raised skin patches (plaques) covered with scales which can be itchy. The extent of the affected area varies widely from person to person, but some commonly-affected areas include the elbows, knees, lower back, and scalp. Patients with psoriasis often have comorbidities such as joint pain (psoriatic arthritis), obesity, hypertension, diabetes, and cardiovascular disease. Psoriasis affects 1-2% of the U.S. population, with an even prevalence between males and females, and it has a strong genetic link.
What is the typical regimen for taking care of psoriasis and managing a patient’s psoriasis?
The approach to treating psoriasis varies depending on the severity of the patient’s disease and existing comorbidities. Topical therapies are the mainstay for most patients with mild-moderate psoriasis. Corticosteroids are generally the most effective of the topical therapies, but other topicals are often used in combination with corticosteroids. Phototherapy, which is a treatment that emits a type of UV radiation, administered in clinic or by a special home device is an effective and safe therapy when topicals fail to adequately control disease or when large quantities of topical therapies are required. Oral therapies such as methotrexate can be used for more severe disease and are usually reserved for patients who have tried other treatments. Biologic medications are the most effective type of treatment for severe disease. These are injected under the skin by patients as frequently as twice per week or as infrequently as every 3 months. The cost of biologics therapies is much higher than other treatments, and thus they are reserved for patients whose disease is not adequately controlled with multiple other therapies.
You completed research for GHC-SCW using a different cost saving medication for members with psoriasis! Can you explain what that research was?
At GHC-SCW, we are constantly looking for ways to reduce the cost of medications to our members. This can result in lower copays at pharmacies and lower monthly premiums. For our members with severe psoriasis who required a biologic therapy to control their disease, GHC-SCW worked with our partners to reduce the cost of one of the newer and most effective biologic drugs for psoriasis. By doing this, our members gained access to a very effective and safe therapy at a lower price for the cooperative. The change had a positive impact on members in two ways. The first way is that members who were currently using an alternative biologic therapy were switched to the newer therapy. The second way is that members had access to this therapy when they required treatment with their first biologic. During the transition to the newer biologic, we kept track of our members who were using it to make sure it worked as well as expected.
What were the results of that research? Did you patients/members see an improvement in symptoms in addition to less costs?
GHC-SCW is excited to report that the initiative to lower costs and improve outcomes for our members with psoriasis was a remarkable success. Most of our members experienced some improvement in their skin compared to what they were achieving with their prior biologic, and the members who had complete control of their skin before making the switch did not lose that control. These impressive results were achieved while also reducing costs.
How can GHC-SCW members work with the clinical pharmacy team to adjust their medication for psoriasis and other diseases?
GHC-SCW’s Clinical Pharmacists are well-trained pharmacists who work with our patients and their GHC-SCW care teams to optimize drug treatments and help reduce cost when possible. Some of the ways clinical pharmacists help our patients include: assisting providers with prescribing choices, drug interactions, and dosing; gathering and reviewing a patient’s full list of medications and making recommendations to optimize therapy; meeting with patients directly to address concerns about side effects, drug interactions, drug costs, and more; educating patients about lifestyle and drug treatments, prescribing drugs, and monitoring labs for some chronic diseases. For access to these services, members may reach out to their GHC-SCW provider or GHC-SCW pharmacy!
With fall high school sports starting in the upcoming weeks, high school athletes and parents need to be ready to prevent injuries so they can stay in the game!
This week, we sat down with Shannon Jegla, DPT and Rebekah Steidinger, DPT, to learn more about common injuries in high school athletes, what it means to get a concussion, and how to prevent injuries before they happen.
Back to school is coming up, meaning high school sports are coming back! Are there any common injuries you see in athletes?
Unfortunately, we will see an increase in ACL tears in young athletes beginning this fall and continuing throughout the year. The sports with the highest incidence are soccer, basketball, and football; we see them more commonly in our female athletes. Outside of more acute injuries, we are seeing more and more overuse injuries in young athletes who are now at a level within their sport that requires year-round training. These include stress injuries to bones and tendons.
What can athletes do help prevent these injuries, on the field and off the field?
When it comes to overuse injuries, cross-training is essential. Doing the same motion most days or daily can overload the tissue, especially in growing bodies. Using “off days” to rest from the sport is important. Still, it can also be helpful to move in different ways than your sport demands—think swimming or yoga for a running athlete or lacrosse or baseball for a hockey or basketball athlete. Variety is key!
On the field, it is vital to have proper, well-fitted equipment or footwear on the field and to ensure those stay in good shape throughout the season. And listen to your body! If something happens during practice or a game that doesn’t feel right, talk to your athletic trainer or coach and let them know what is happening. Ignoring the problem isn’t going to make it go away.
Concussions are a big concern in sports like football, soccer, and even swimming! What happens when an athlete gets a concussion?
Concussions, or mild traumatic brain injuries, can occur from a direct impact to the head or a rapid movement of the brain within your skull. This leads to physical, mental and emotional symptoms due to chemical changes in the brain and mechanical stresses to your neck. The body and brain are typically very good at healing after a concussion if given proper treatment and rest. Symptoms can happen immediately but sometimes can be delayed for several hours after injury, so you should always take yourself out of any gameplay if you feel like you may have experienced a concussion. Symptom duration will last days to months, depending on the person and situation.
Why should parents/high school athletes be concerned about concussions in sports?
Concussions are essential to prevent, identify and treat correctly as they can affect many aspects of your life. The most common symptoms include difficulty with cognitive tasks and concentration, memory issues, headaches, dizziness, balance deficits, sleep issues, neck pain, mood changes, and sensitivity to light and sound. They can also take longer and be harder to heal from the more concussions you experience.
Is there anything athletes can do to prevent concussions?
One meaningful way to prevent a concussion is always wearing a helmet when needed on the field, on a bicycle, skiing, or in any other activity where you are at risk of sustaining a head injury. It is also important to play smart and avoid making illegal contact with other players. With any sport that involves stunting, make sure always to use spotters in a safe environment. If running or biking outside for conditioning or sport, make sure you are visible to cars and others around you. Game administrators can do their part by ensuring that equipment is in good condition, tripping hazards are minimized, and fields are in good condition. If you sustain a concussion, it is crucial to avoid any activity that may risk a repeat injury to the head and be evaluated by a medical provider.
What advice would you give to athletes before starting their season?
Pre-season preparation and progressive conditioning after a scheduled rest period is the best way to ensure your body is ready for the demands of your sport. If you have any nagging injuries, make sure you connect with your coach and athletic trainer to have a plan in place to manage them. Adequate sleep, proper nutrition, and consistent hydration are part of the foundation of injury prevention, especially as the school year gets rolling and busier.