Papers by Joseph Thevathasan
British Journal of Dermatology, 2025
Autoimmune conditions with overlapping dermatological and rheumatological manifestations present ... more Autoimmune conditions with overlapping dermatological and rheumatological manifestations present significant management challenges in rural healthcare settings. The aim of this study was to evaluate whether a newly established combined dermatology–rheumatology clinic could improve healthcare access and patient satisfaction while maintaining clinical effectiveness. This service was delivered through cross-trust collaboration between two hospitals situated approximately 30 miles apart, serving a geographically dispersed population with significant access barriers. A 6-month prospective quality improvement initiative was conducted from April to October 2022. Monthly combined consultant-led clinics were evaluated using structured questionnaires assessing patient satisfaction, operational efficiency and educational impact. The service integrated specialist care between distinct National Health Service trusts, centralizing care delivery at a single site to enhance healthcare equity for traditionally underserved rural populations. Data collection included both quantitative metrics and qualitative responses from patients attending these integrated clinics. Data were analysed using descriptive statistics, with 95% confidence intervals (CIs) calculated for key metrics. Qualitative responses were coded thematically to identify common patterns. The study demonstrated unanimous patient satisfaction at 100% (49 of 49, 95% CI 92.7–100) with the combined clinic format. Healthcare access improved significantly, with 92% (45 of 49, 95% CI 78.1–98.3) reporting reduced travel costs and 96% (44 of 46, 95% CI 85.5–99.5) citing streamlined appointment coordination. This impact is particularly significant given the region’s poor public transport infrastructure, which has seen a substantial decline in bus services over the past decade. Employment impact analysis revealed that while 31% (15 of 49, 95% CI 17.7–43.5) of patients previously required time off work for separate appointments, the combined clinic significantly reduced this burden. Qualitative analysis identified consistent themes of improved comprehensive care delivery and enhanced time efficiency. The clinic proved particularly beneficial for managing complex conditions such as psoriatic arthritis and systemic lupus erythematosus, where concurrent specialist evaluation facilitated more precise diagnostic formulation and therapeutic planning. Educational benefits were noted among participating medical students, who reported enhanced understanding of interdisciplinary care and complex disease management. In conclusion, the combined dermatology–rheumatology clinic demonstrates significant efficacy in addressing healthcare inequities in rural settings, with high patient satisfaction and operational efficiency. This cross-trust collaborative model shows particular value in managing complex autoimmune conditions requiring multispecialty input while simultaneously reducing travel burden and improving care coordination. These findings support the broader implementation of integrated specialty clinics across geographically dispersed regions, with potential applications for other specialty combinations.
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Papers by Joseph Thevathasan