Date of Award

2017

Document Type

Open Access Dissertation

Department

College of Nursing

Sub-Department

Nursing Practice

First Advisor

Stephanie Burgess

Abstract

The purpose of this quality improvement project was to determine if screening primary care patients with psoriasis will improve early detection of celiac disease (CD), rheumatoid arthritis, and Crohn’s disease (CrD). The aim of this project is to assess the utility of early screening in patients with psoriasis in order to facilitate earlier diagnosis of CD, RA and CrD, which would consequently initiate earlier treatment and improve long-term patient outcomes. Genetic and population-based studies suggest that individuals with psoriasis have a greater risk of also having CrD, CD or RA, than do individuals without psoriasis. The literature also suggests that health care providers would be prudent to evaluate psoriatic patients in a prospective manner for these AI disorders in order to improve the patient’s long-term health outcomes.

Based on the literature, the DNP project investigator developed a nonpsychometric patient questionnaire to capture data including the signs and symptoms of CD, CrD and RA and three referral algorithms (one each per CD, CrD and RA). Over two weeks at a Northern Virginia dermatology clinic, the patient questionnaire was delivered to 261 adult patients, of which 34 were identified as psoriatic or newly diagnosed.

Findings indicated 100% provider compliance documentation for all 34 patients noting that the patient a) had been screened, and b) if referral was or was not indicated. Frequency data indicated that the most reported symptom was a history of vitamin D deficiency (38.24%). Thirty percent of psoriatic patients reported having a first-degree relative with celiac disease, Crohn’s disease or rheumatoid arthritis. The most frequently reported symptoms were for rheumatoid arthritis: daily joint or muscle pain > 6 weeks (29.41%), daily tender or swollen joints > 6 weeks (23.53%), and weakness or fatigue > 6 weeks (23.53%). The most reported GI symptom was abdominal distention and/or bloating after eating (14.71%). The least reported symptoms, at 2.94% each, were abdominal pain after eating, painful bowel movements, and running a fever in the past 4 weeks. This quality improvement project highlights the need to evaluate adult patients with psoriasis for polyautoimmunity and familial autoimmunity and is consistent with the literature that recommends screening for these polyimmune relationships.

Rights

© 2017, Susan Danielle Ashbaugh

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