Immune-mediated inflammatory skin disease (IMIDs) is an umbrella term grouping together heterogeneous entities characterized by chronic inflammation involving the skin. Psoriasis, atopic dermatitis and vitiligo are well-known examples of IMIDs. Topical, phototherapy, systemic therapy and biological treatments aim to control many of these diseases, however, IMIDs are often associated with multiple comorbidities such as (psoriasis) arthritis, inflammatory bowel diseases or anxiety and depression and these are often undertreated. In addition, positive lifestyle behavior within this population is important to reduce the raised risk of developing or worsening hypertension, dyslipidemia, metabolic syndrome and even cancer. In our current healthcare delivery system, medical care is not presented to patients in an integrated manner. Care is ‘siloed’ and typically delivered in single medical interventions which are paid and reimbursed regardless of the outcome or the level of integration around a disease. Seen the high impact of IMIDs, patients require an integrated approach, but structural solutions are needed to create such a sustainable healthcare system. Value-Based Healthcare (VBHC) provides such a framework and strives to maximize the value for patients, by achieving the best possible outcome for patients against the lowest possible cost. One of the principles of VBHC that we have implemented at the department of dermatology of Ghent University Hospital, is organizing into ‘Integrated Practice Units’ (IPUs). An IPU is and organizational entity that connects multiple specialisms around a medical condition and aims to provide integrated care to patients while taking into account patient outcomes and costs. During these specialized consultations, an in-depth anamnesis is conducted, including comorbidity screening and patients are informed and supported in lifestyle behavior change. Education about the skin disease, its treatments, associated comorbidities, and lifestyle behavior, is provided continuously. If needed, we also invite our patients to our ‘nurse-led lifestyle intervention’ where specific lifestyle issues are addressed. 

Within these IPUs, we often see that our patients are undertreated, not only in relation to their skin disease e.g. psoriasis, atopic dermatitis, vitiligo or hidradenitis suppurativa, but also for their comorbidities. With regard to risk factors for cancer, a high proportion of the patients are smokers, has overweight or obesity and consumes more than 10 units of alcohol per week. This indicates that comorbidity screening and lifestyle behavior change should be managed.

Consequently, we aim to tackles these issues by providing integrated care, also with our nurse-led lifestyle intervention and motivational interviewing, by adapting our comorbidity guidelines and referral policy, creating comorbidity awareness and by integrating ‘comorbidity control’ as treatment goal.