PS06 Exploring drivers of clinical improvement in dermatological–psychiatric care

Abstract Dermatopsychiatric patients face significant challenges due to complex needs and limited treatment options, often leading to unpredictable clinical outcomes. While dermatopsychiatry patients have been shown to have significantly less trust in their doctors’ medical judgements compared with general dermatology patients, the impact of this gap on clinical outcomes has not yet been systematically explored, hindering efforts to optimize care (Stavrou P, Gkini M, Taylor R, Bewley A. Exploring patient–physician trust dynamics in patients with psychocutaneous and general dermatological disease. Br J Dermatol 2020; 184: 568–70). Understanding the factors that lead to clinical improvement could provide critical guidance for managing these challenging cases. This study is among the first to bridge this gap by exploring how patient receptiveness to their physician’s care and other clinical variables influence clinical improvement in a dermatological–psychiatric setting. We conducted a retrospective chart review on every patient (n = 47) seen by our joint dermatology–psychiatry clinic since August 2019, assessing patient characteristics, comorbidities, receptiveness to care, diagnosis, treatment and clinical improvement. In the absence of a standardized screening tool for assessing patients’ receptiveness to care, a proprietary categorization protocol was developed to categorize receptiveness as ‘yes’, ‘somewhat’ or ‘no’ based on key indicators documented by the attending physician. These included patients’ expressed interest in follow-up visits, agreement with the treatment plan and medication compliance. Clinical improvement was determined as yes or no based on a thorough review of physician chart notes documenting observed progress in the condition or improvement in dermatological or psychiatric symptoms. This methodology ensured a structured and uniform assessment across all cases. Of the patients seen, 81% were female, and the average age was 54 years (interquartile range 41–62). Twenty-six (55%) had a psychiatric comorbidity and 35% reported substance use. Of the 47 patients, 79% (n = 37) showed clinical improvement. Patient demographics, medication prescriptions or psychiatric comorbidities were not predictors of clinical improvement. Significant predictors of improvement included receptiveness to care (odds ratio 26.3, 95% confidence interval 3.90–176; P < 0.001) and consistent appointment attendance (P = 0.042). Patients with body-focused repetitive behaviour disorders had higher rates of clinical improvement (odds ratio 16.6, 95% confidence interval 1.89–146; P = 0.008). Modifiable factors like receptiveness to care and follow-up attendance significantly influence outcomes for dermatopsychiatric patients. Implementing trust-building protocols, including comprehensive patient education or flexible scheduling, into dermatopsychiatric consultations could enhance this receptiveness, thereby improving overall care outcomes. These findings support the expansion of integrated care models within the UK, aligning with national guidelines to advance targeted, patient-centred strategies in dermatological–psychiatric care.