title: Healthcare Provider Type and Switch to Biologics in Psoriasis: Evidence from Real-World Practice.
abstract: BACKGROUND
  Previous research indicates an uneven uptake of biologics in patients with moderate-to-severe psoriasis in Sweden. Therefore, it is essential to scrutinise variations in treatment patterns.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the extent to which the uptake of biologics for psoriasis differs between types of healthcare provider.
  
  
  METHODS
  Three types of provider were identified within 52 units participating in the Swedish National Registry for Systemic Psoriasis Treatment (PsoReg): university hospitals, non-university hospitals and individual practices. Biologics-naïve patients (n = 3165) were included in analyses to investigate the probability of switch to biologics. The numbers of patients fulfilling the criteria for moderate-to-severe psoriasis [Psoriasis Area and Severity Index (PASI) ≥10 and Dermatology Life Quality Index (DLQI) ≥10] among patients who switched to biologics and patients who did not switch were reported. A logistic regression model was used to calculate how healthcare provider type influenced the probability of switch to biologics whilst adjusting for patient characteristics and disease severity.
  
  
  RESULTS
  During registration, 16% of patients switched to biologics while 84% remained on conventional systemic treatment. In 7% of patients, the criteria PASI ≥10 and DLQI ≥10 was fulfilled at their last visit without switching to biologics, whereas in 10% of patients the criteria was not fulfilled prior to switch. After controlling for patient characteristics and disease severity, small or no difference in the probability of switch was observed between provider types.
  
  
  CONCLUSIONS
  Disease severity does not explain the decision to switch or not to switch to biologics for a disproportionate number of patients. There seems to be an uneven uptake of biologics in Swedish clinical practice, but the type of healthcare provider cannot explain this variation. More research is needed on what factors influence the prescription of biologics.
authors.affiliation: The Swedish Institute for Health Economics (IHE), Lund, Sweden.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Calara
authors.affiliation: The Swedish Institute for Health Economics (IHE), Lund, Sweden.
authors.forename: Jenny M
authors.initials: JM
authors.lastname: Norlin
authors.affiliation: The Swedish Institute for Health Economics (IHE), Lund, Sweden.
authors.forename: Rikard
authors.initials: R
authors.lastname: Althin
authors.affiliation: The Swedish Institute for Health Economics (IHE), Lund, Sweden.|Department of Clinical Sciences, Malmö, Lund University, Lund, Sweden.
authors.forename: Katarina Steen
authors.initials: KS
authors.lastname: Carlsson
authors.affiliation: Department of Public Health and Clinical Medicine, Dermatology, Umeå University, 901 87, Umeå, Sweden. marcus.schmitt-egenolf@umu.se.
authors.forename: Marcus
authors.identifier: http://orcid.org/0000-0002-3858-8474
authors.initials: M
authors.lastname: Schmitt-Egenolf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001688:Biological Products / Q000627:therapeutic use*; D002648:Child; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy*; D012720:Severity of Illness Index; D013548:Sweden; D055815:Young Adult
chemical_list: D001688:Biological Products