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Quiles-Tsimaratos N, Paul C, De La Brassinne M, Telle-Sauvant H, Corgibet-Escallier F, Tanasescu S, Roux B, Girardot-Seguin S, Duval-Modeste AB. Decision-making factors for the long-term topical treatment of mild-to-moderate plaque psoriasis: TEPPSO, a case-vignette study on clinical practice. Ann Dermatol Venereol 2023; 150:28-34. [PMID: 35787804 DOI: 10.1016/j.annder.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/01/2022] [Accepted: 05/09/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Topical maintenance therapy strategy with regard to patients with mild-to-moderate plaque psoriasis (PP) continues to be heterogeneous and insufficiently investigated in real-life clinical practice. The objective of this study was to describe the initiation of long-term maintenance treatment and to identify clinical parameters influencing the therapeutic decision. METHODS TEPPSO was a French and Belgian multicentre cross-sectional study based on completion of questionnaires and assessment of credible clinical scenarios of mild-to-moderate PP by physicians using the validated case-vignette method. RESULTS Maintenance therapy was recommended by dermatologists (Ds) and by general practitioners (GPs) in 79.1% and 76.8% of cases, respectively. GPs recommended the use of a fixed-dose combination of corticosteroid and vitamin D analogues in only 14.8% of cases, whereas this therapy was recommended by French and Belgian Ds in 54.8% and 39.8% of cases, respectively. In a multivariate analysis, significant determinants of the therapeutic decision were skin lesions impacting quality of life (OR 1.9 [95% CI: 1.1; 3.2] P=0.01) for Ds, and patient corticophobia (OR 1.7 [95% CI: 1.1; 2.7] P=0.03) or the presence of skin pruritus (OR 1.8 [95% CI: 1.2; 1.8] P=0.004) for GPs, respectively. CONCLUSIONS Maintenance treatment with topical agents in patients with mild-to-moderate PP was considered in more than two thirds of cases. Heterogeneity in the choice of topical agents was evidenced particularly between Ds and GPs. Our study is the first to identify significant clinical determinants affecting the therapeutic decision. Updated and validated clinical practice guidelines are needed to ensure uniform therapeutic choices.
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Affiliation(s)
| | - C Paul
- Dermatologie, Hôpital Larrey, Toulouse, France
| | | | | | | | - S Tanasescu
- Dermatologie, Clinique Du Cèdre, Bois-Guillaume, France
| | - B Roux
- Recherche clinique, Société FAST4, Nîmes, France
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Parinyarux P, Thavornwattanayong W, Soontornpas C, Rawangnam P. Towards Better CARE for Superficial Fungal Infections: A Consultation Guide for the Community Pharmacy. PHARMACY 2022; 10:pharmacy10010029. [PMID: 35202078 PMCID: PMC8878117 DOI: 10.3390/pharmacy10010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/03/2022] [Accepted: 02/09/2022] [Indexed: 12/10/2022] Open
Abstract
Superficial fungal infections (SFIs) are among the most common skin diseases worldwide and are common in many parts of Asia. Community pharmacists are well-placed to help identify and manage SFIs. However, effective management may be hindered by a suboptimal consultation process, attributed to the misalignment between consumers’ and pharmacists’ viewpoints. The Fungal CARE (Care, Assess, Recommend, Empower) guide, a patient-centered collaborative framework, was developed to improve pharmacist-led SFI consultations in community pharmacy. A survey on real-world consumer experiences with SFIs provided insights for aligning the Fungal CARE guide with consumer perspectives. To further optimize the guide, community pharmacists were surveyed on their current practice and challenges of managing SFIs, as well as views on the usefulness of the Fungal CARE guide. The pharmacists’ survey indicated that respondents engaged with some but not all of consumers’ top concerns with SFIs, such as emotional and social aspects. Pharmacists identified their greatest challenges as poor compliance with SFI treatment and limited confidence in identifying and/or managing SFIs. Encouragingly, when presented with the Fungal CARE guide, nearly all pharmacists agreed it would be helpful and would use it in practice. Implementing the Fungal CARE guide may help improve pharmacist-led consultations for SFIs and encourage better treatment outcomes.
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Affiliation(s)
| | - Wiwat Thavornwattanayong
- Faculty of Pharmacy, Silpakorn University, Nakorn Pathom 73000, Thailand
- Correspondence: ; Tel.: +66-3425-5800
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Tsunemi Y, Nakahigashi H. Clinical study on the effects of the applied volume of moisturizer in patients with asteatosis. J Dermatol 2021; 49:75-85. [PMID: 34545613 PMCID: PMC9292982 DOI: 10.1111/1346-8138.16160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 11/30/2022]
Abstract
Asteatosis is characterized by decreased stratum corneum water content, and the basic treatment is to keep the skin moisturized. Poor application of moisturizers by patients may reduce treatment efficiency, so it is important to continue application as instructed by dermatologists. Application instructions based on the finger‐tip unit are useful for patients, but there is no clear evidence of its efficacy. We investigated the effects of the volume of the moisturizer (Hirudoid® Cream 0.3%) administrated with 1/3 finger‐tip unit and 1 finger‐tip unit equivalent doses per target lower leg of patients with asteatosis (twice daily, 28 days) on the overall dry skin scores, itch numerical rating scale scores, and skin physiological parameters (stratum corneum water content, transepidermal water loss, and skin pH). Sixty patients were randomized with a 1:1 allocation ratio into two groups: the 1/3 finger‐tip unit and 1 finger‐tip unit equivalent dose groups. The results showed that 43.3% of the patients in the 1 finger‐tip unit equivalent dose group, compared with 13.3% in the 1/3 finger‐tip unit equivalent dose group, presented zero overall dry skin scores 1 week later. As the overall dry skin scores improved, the stratum corneum water content also increased. In patients with moderate itching, the itch numerical rating scale scores of the 1 finger‐tip unit equivalent dose group decreased significantly compared with those of the 1/3 finger‐tip unit equivalent dose group. The results suggested that the application of 1 finger‐tip unit equivalent dose of the moisturizer twice daily in clinical practice could induce remission more quickly. With the 1/3 finger‐tip unit equivalent dose, prolonged treatment may be necessary to achieve the desired effect; therefore, application adherence is strictly required. In conclusion, the application of a 1 finger‐tip unit equivalent dose would be quite reasonable in clinical practice.
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Affiliation(s)
- Yuichiro Tsunemi
- Department of Dermatology, Saitama Medical University, Saitama, Japan.,Medical Corporation Shinanokai, Shinanozaka Clinic, Tokyo, Japan
| | - Haruka Nakahigashi
- Clinical Development Department, Kyoto R&D Center, Maruho Co., Ltd., Kyoto, Japan
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4
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Teixeira A, Teixeira M, Bento C, Azevedo LF, Vasconcelos V, Bahia MF, Torres T, Morna C, Castro E, Vidal DG, E Sousa HFP, Dinis MAP, Almeida IF, Almeida V. Patterns of dosage regimen instructions regarding topical medicines: how is the information perceived by patients? J DERMATOL TREAT 2021; 33:2325-2330. [PMID: 34334082 DOI: 10.1080/09546634.2021.1960262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The communication of dosage regimen instructions by physicians is of utmost importance on treatment adherence. Few studies until now have approached the topical treatment adherence subject. OBJECTIVE This study aims the characterization of dosage regimen instructions given by physicians and the assessment of chronic dermatological patients' perception regarding these instructions. METHODS Two instruments one for physicians (PHYSDOSAGE) and one for patients (PATIENTDOSAGE) were developed and applied in a cross-sectional, descriptive and exploratory study to two independent samples composed by 91 physicians and 43 patients. RESULTS Most of physicians reported to provide dosage regimen instructions. When cross checking information from both studied samples, physicians and patients, it was concluded that physicians reported to provide more frequently oral and written treatment instructions, e.g. electronic prescription, than patients reported having received it. Also, physicians claimed to often provide information about the duration of treatment and the frequency of topical medicines' application, which was not acknowledged by patients. CONCLUSIONS Contradictory results were found between the physicians' information input and the patients' perception about dosage regimen instructions provided during the consultation. These findings could negatively influence the treatment adherence and the clinical outcomes. Thus, it is of paramount importance the implementation of strategies to improve optimal communication of dosage regimen instructions for topical medicines.
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Affiliation(s)
- Ana Teixeira
- CESPU, Institute on Research and Advanced Training in Health Sciences and Technologies, Gandra PRD, Portugal.,UCIBIO/REQUIMTE, MedTec-Laboratório de Tecnologia Farmacêutica, Departamento de Ciências do Medicamento, Faculdade de Farmácia, Universidade do Porto, Portugal
| | - Maribel Teixeira
- CESPU, Institute on Research and Advanced Training in Health Sciences and Technologies, Gandra PRD, Portugal
| | - Carmen Bento
- Universitary Clinic of Paediatrics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Luís Filipe Azevedo
- Department of Health Information and Decision Sciences (CIDES) and Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, University of Porto, Portugal
| | - Viviana Vasconcelos
- CESPU, Institute on Research and Advanced Training in Health Sciences and Technologies, Gandra PRD, Portugal
| | - Maria Fernanda Bahia
- UCIBIO/REQUIMTE, MedTec-Laboratório de Tecnologia Farmacêutica, Departamento de Ciências do Medicamento, Faculdade de Farmácia, Universidade do Porto, Portugal
| | - Tiago Torres
- Serviço de Dermatologia, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal
| | - Carla Morna
- USF das Ondas, Aces Grande Porto IV-Póvoa de Varzim/Vila do Conde, Vila do Conde, Portugal
| | - Eunice Castro
- Serviço de Imunoalergologia, Centro Hospitalar de S. João, Porto, Portugal
| | - Diogo Guedes Vidal
- UFP Energy, Environment and Health Research Unit (FP-ENAS, University Fernando Pessoa (UFP), Porto, Portugal)
| | | | - Maria Alzira Pimenta Dinis
- UFP Energy, Environment and Health Research Unit (FP-ENAS, University Fernando Pessoa (UFP), Porto, Portugal)
| | - Isabel F Almeida
- UCIBIO/REQUIMTE, MedTec-Laboratório de Tecnologia Farmacêutica, Departamento de Ciências do Medicamento, Faculdade de Farmácia, Universidade do Porto, Portugal
| | - Vera Almeida
- CESPU, Institute on Research and Advanced Training in Health Sciences and Technologies, Gandra PRD, Portugal.,UCIBIO/REQUIMTE, MedTec-Laboratório de Tecnologia Farmacêutica, Departamento de Ciências do Medicamento, Faculdade de Farmácia, Universidade do Porto, Portugal
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Knowledge and Practices of Community Pharmacists in Topical Dermatological Treatments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062928. [PMID: 33809303 PMCID: PMC8000358 DOI: 10.3390/ijerph18062928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/05/2021] [Accepted: 03/11/2021] [Indexed: 12/24/2022]
Abstract
The connection between pharmacists’ knowledge and practice on the provided information to patients about dermatoses and their treatment is insufficiently characterized. Furthermore, pharmacists’ contributions in counselling and in promoting adherence to topical treatment is not fully understood. This study has three main objectives. It aims to identify the knowledge and practices of pharmacists about dermatoses and their treatment, and to compare the perspective of pharmacists with that of patients regarding treatment information, with the future goal of establishing guidelines on the communication of dosage regimen instructions to dermatological patients and promotion of adherence to treatment, filling a gap. A cross-sectional, exploratory, and descriptive study was carried out. Based on experts’ prior knowledge and extensive collected literature information, two questionnaire protocols, one for pharmacists and another one for patients, were designed. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were carried out in relation to the pharmacists’ questionnaire for instrument validation. The results indicate that knowledge of pharmacists regarding dermatoses and their treatment is considered acceptable. Most of the pharmacists were reported to provide information to patients. Oppositely, patients reported not to have receive it. This is an important issue because pharmacists play a primary role in the management of several diseases. As non-adherence can be triggered by poor understanding of the dosing instructions, pharmacists’ communication practices play an important role in improving this hinderance. Results from this study identified pharmacist–patient communication gaps, so the development of guidelines to improve the transmission of clear dosage regimen instructions and knowledge about patient’s disease are of paramount importance. Training programs for continuous education of pharmacist should be implemented to solve the identified communication problems found in this study.
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Nakahigashi H, Numazaki T, Nakamura H, Yoshioka D, Ashizuka Y, Yoshimune R, Honda N. [Clinical Research on the Effects of Differences in Properties of External Preparations for Skin on Application Amount: An Exploratory Investigation of the Relationship between the Base Usability and Application Amount by Questionnaire in Adult Subjects]. YAKUGAKU ZASSHI 2019; 139:1313-1325. [PMID: 31231102 DOI: 10.1248/yakushi.19-00091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Compared to oral medication, the base plays a large role in the external preparation for skin, and dermatologists select the dosage form based on understanding of the effect of the base as well as according to skin symptoms and conditions, application site, age, season, etc. Further, in treatment with external preparations, it is important for patients to understand the application method and continue to apply an adequate amount to achieve the treatment goal. However, there is little evidence regarding the relationship between base properties or usability and the application amount. In this study, we investigated the usability and application amount of three bases with different properties (ointment base, cream base, and lotion base) in 62 adult subjects and exploratively examined the effect of the different base properties on the application amount. The results of this clinical study showed that the usability and preference for the base used for external preparations varies, and poor usability and low preference may lead to a reduction in the application amount. Even with good usability and high preference, there were many cases in which an adequate amount was not applied due to lack of specific instructions on external use. When selecting or changing the base in an external therapy, it is important for not only dermatologists but also pharmacists providing instructions on external use to be aware of the importance of the base and actively instruct patients to apply an adequate amount of the preparation.
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Affiliation(s)
| | - Toshiya Numazaki
- Maruho Co., Ltd., Kyoto R&D Center, Clinical Development Department
| | | | | | - Yuki Ashizuka
- Maruho Co., Ltd., Kyoto R&D Center, CMC Research Laboratories
| | | | - Noriko Honda
- Maruho Co., Ltd., Kyoto R&D Center, Clinical Development Department
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7
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Homayoon D, Dahlhoff P, Augustin M. [Adequate prescription and application of topicals : How to calculate the right volume for the prescription of ointment needed?]. Hautarzt 2019; 69:478-483. [PMID: 29247255 DOI: 10.1007/s00105-017-4088-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uncertainty regarding the suitable amount of prescribed ointment and its application by patients may cause insufficient or uneconomic health care provision. To address this issue, standardized methods and experts' knowledge on the suitable amount and coherent patient's elucidation for application of topicals are needed. OBJECTIVES Presented are current data in routine care and scientific evidence on the prescribed amount of topical agents as well as its application by patients in dermatological care. MATERIALS AND METHODS A literature review was conducted via PubMed using the keywords as individual and pooled search terms: "local therapy", "topical treatment", "prescription", "amount of ointment needed", "involved area", "BSA", "finger-tip-unit", "Rule of Hand", "calculated dosage" and "rule of nines". We included original studies by manually screening title and abstract according to the relevance of the topic. RESULTS The search strategy identified 19 clinical trials. The fingertip unit (FTU) is the most frequently used measurement for accurate application of external agents. Appropriate prescribed amount is calculated by required topical agent per involved surface area. CONCLUSIONS There is still a need for clarification to which extent the optimized amount of ointment is prescribed and advice for its application in routine care is given. The FTU combined with the "Rule of Hand" is an adequate measurement for patient's guidance on self-application.
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Affiliation(s)
- D Homayoon
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland.
| | - P Dahlhoff
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
| | - M Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland
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8
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Speeckaert R, Hoorens I, Corthals S, Delbaere L, Lambert J, Lesseliers T, Mylle S, Ongenae K, De Schepper S, De Smet L, Speeckaert M, van Geel N. Comparison of methods to estimate the affected body surface area and the dosage of topical treatments in psoriasis and atopic dermatitis: the advantage of a picture-based tool. J Eur Acad Dermatol Venereol 2019; 33:1726-1732. [PMID: 31166638 DOI: 10.1111/jdv.15726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 05/17/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The accurate determination of the dosage of topical treatments is important given its repercussions on patient adherence and therapeutic efficacy. Up till now, the fingertip unit calculated by the rule of hands is considered the gold standard, although its use is associated with several drawbacks. OBJECTIVE To compare different methods to estimate the affected body surface area (BSA) and dosage of topical treatments in atopic dermatitis and psoriasis and investigate its reliability, user-friendliness and timing. METHODS In this study, we compared the reliability of three different methods: (i) the fingertip unit calculated by the 1% hand rule; (ii) a picture-based tool [termed Cutaneous Inflammatory Disease Extent Score (CIDES)]; and (iii) a digital drawing tool. Eleven observers scored 40 patients with psoriasis and eczema to assess the inter-rater and intrarater reliability. Timing was automatically recorded, and user-friendliness was investigated by a questionnaire. RESULTS An excellent intraclass correlation (ICC) was found for both inter-rater agreement and intrarater agreement for the picture-based tool (ICC = 0.92 and ICC = 0.96, respectively). The ICCs for drawing the area of involvement on a silhouette were 0.89 and 0.93, respectively. Finally, the rule of hands was associated with an increased inter-rater variability although an excellent intrarater agreement was found (ICC = 0.79 and 0.95, respectively). Automated calculation of the amount of topical treatment improved reliability, and CIDES was associated with the least variation. CIDES was considered the preferred method by all observers and was fast to perform (median: 30 s). CONCLUSION A picture-based method offered the most advantages (in terms of reliability, speed and user-friendliness) to estimate the affected BSA and calculate the dosage of topical treatments.
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Affiliation(s)
- R Speeckaert
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
| | - I Hoorens
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
| | - S Corthals
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
| | - L Delbaere
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
| | - J Lambert
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
| | - T Lesseliers
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
| | - S Mylle
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
| | - K Ongenae
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
| | - S De Schepper
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
| | - L De Smet
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
| | - M Speeckaert
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
| | - N van Geel
- Department of Dermatology, Ghent University Hospital, Gent, Belgium
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Caldarola G, De Simone C, Moretta G, Poscia A, Peris K. Role of personalized medication training in improving efficacy and adherence to a topical therapy in psoriatic patients. J DERMATOL TREAT 2017; 28:722-725. [DOI: 10.1080/09546634.2017.1328100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- G. Caldarola
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - C. De Simone
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - G. Moretta
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - A. Poscia
- Department of Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy
| | - K. Peris
- Department of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
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10
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Eissing L, Radtke M, Zander N, Augustin M. Barriers to guideline-compliant psoriasis care: analyses and concepts. J Eur Acad Dermatol Venereol 2015; 30:569-75. [DOI: 10.1111/jdv.13452] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/04/2015] [Indexed: 12/18/2022]
Affiliation(s)
- L. Eissing
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - M.A. Radtke
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - N. Zander
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
| | - M. Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP); University Medical Center Hamburg-Eppendorf (UKE); Hamburg Germany
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Burroni AG, Fassino M, Torti A, Visentin E. How do disease perception, treatment features, and dermatologist-patient relationship impact on patients assuming topical treatment? An Italian survey. PATIENT-RELATED OUTCOME MEASURES 2015; 6:9-17. [PMID: 25733940 PMCID: PMC4337690 DOI: 10.2147/prom.s76551] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Psoriasis largely affects daily activities and social interactions and has a strong impact on patients’ quality of life. Psoriatic patients have different attitudes toward their condition. Topical medications are essential for the treatment of psoriasis, but the majority of patients do not adhere to these therapies. Objective The history of treatment success or failure seems to influence patient attitude toward topical therapy. Therefore, it is important to understand the psychological, experiential, and motivational aspects that could be critical for treatment adherence, and to describe the different attitudes toward topical treatment. Furthermore, the physician–patient relationship and the willingness to trust the dermatologist may have a substantial role in encouraging or discouraging patients’ attitudes toward topical therapy. Methods A survey was designed to collect aspects that could be relevant to understanding different patient attitudes toward psoriasis and its treatments. A total of 495 self-administered questionnaires compiled by psoriatic patients were analyzed from 20 Italian specialized hospital centers in order to provide a nationwide picture. Results Psoriatic patients have different perceptions and experiences in relation to their condition: half of them consider psoriasis as a disease, while the other half consider psoriasis as a disorder or a nuisance. Topical therapy is the most widely used treatment, even though it is not considered the most effective one and often perceived to be cosmetic. The main findings are: 1) inadequate patient education about this disease, 2) lack of information about topical treatment, and 3) lack of results within the expected time frame. Furthermore, physicians need to build a good relationship with psoriatic patients in order to motivate them, to trust in their care, and to adhere to treatment. Conclusion This survey adds new and important details about daily life and well-being and the needs of psoriatic patients, providing suggestions for dermatologists to improve patients management.
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Affiliation(s)
- Anna Graziella Burroni
- IRCCS University Hospital San Martino, IST National Institute for Cancer Research, Genoa, Italy
| | - Mariella Fassino
- Department of Psychology, Specialization School in Clinical Psychology, University of Turin, Turin, Italy
| | | | - Elena Visentin
- HTA and Scientific Support, CSD Medical Research Srl, Milan, Italy
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Puig L, Carrascosa J, Belinchón I, Fernández-Redondo V, Carretero G, Ruiz-Carrascosa J, Careaga J, de la Cueva P, Gárate M, Ribera M. Adherencia y satisfacción del paciente y características organolépticas y de uso de los tratamientos tópicos utilizados para la psoriasis: Consenso Delphi del panel de expertos y miembros del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:488-96. [DOI: 10.1016/j.ad.2012.12.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/10/2012] [Accepted: 12/12/2012] [Indexed: 11/25/2022] Open
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Adherence and Patient Satisfaction With Topical Treatment in Psoriasis, and the Use, and Organoleptic Properties of Such Treatments: A Delphi Study With an Expert Panel and Members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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14
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Mason JM, Carr J, Buckley C, Hewitt S, Berry P, Taylor J, Cork MJ. Improved emollient use reduces atopic eczema symptoms and is cost neutral in infants: before-and-after evaluation of a multifaceted educational support programme. BMC DERMATOLOGY 2013; 13:7. [PMID: 23679991 PMCID: PMC3665665 DOI: 10.1186/1471-5945-13-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 04/29/2013] [Indexed: 01/26/2023]
Abstract
Background Parents and carers of children with eczema often underuse emollient therapy, essential to repairing and protecting the defective skin barrier in atopic eczema. Educational interventions delivered by specialist dermatology nurses in hospital settings have been shown to improve emollient use and reduce symptoms of atopic eczema, but benefits of community-based interventions are uncertain. Support and information about appropriate care may often be inadequate for patients and carers in the community. Methods A multifaceted educational support programme was evaluated as a method of increasing emollient use and reducing atopic eczema in children. Support provided for parents and carers included an educational DVD, online daily diary and telephone helpline. The before and after study included 136 British children and their parents, providing baseline and 12 week follow-up data while receiving the programme. Measures included emollient use, POEM and PEST scores, and cost of care. Results Average emollient use increased by 87.6 g (95% CI: 81.9 to 119.5 g, p = 0.001) from baseline with the change being immediate and persistent. The POEM score reduced on average by 5.38 (95% CI: 4.36 to 6.41, p = 0.001), a 47% reduction from baseline. Similarly the PEST score reduced on average by 0.61 (95% CI: 0.47 to 0.75, p = 0.001), a 48% reduction from baseline. Sleep disturbance was reduced by 1.27 nights per week (95% CI: 0.85 to 1.68, p = 0.001) and parental feeling of control improved by 1.32 points (95% CI: 1.16 to 1.48, p = 0.001). From the NHS perspective, the programme was cost neutral overall within the study period. Conclusion A community-based multifaceted educational support programme greatly increased emollient use, reducing symptoms of atopic eczema and general practitioner contacts, without increasing cost. Significant benefits may accrue to the families and carers of children with atopic eczema due to improved sleep patterns and greater feeling of control. PEST, a new simple measure of acute and remitting atopic eczema severity designed to help parents and children to monitor and manage eczema, merits further evaluation.
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Affiliation(s)
- James M Mason
- School of Medicine, Pharmacy & Health, Durham University, Durham, UK
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Ceilley RI, Jorizzo JL. Current issues in the management of actinic keratosis. J Am Acad Dermatol 2013; 68:S28-38. [DOI: 10.1016/j.jaad.2012.09.051] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 09/05/2012] [Indexed: 01/07/2023]
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Devaux S, Castela A, Archier E, Gallini A, Joly P, Misery L, Aractingi S, Aubin F, Bachelez H, Cribier B, Jullien D, Le Maître M, Richard MA, Ortonne JP, Paul C. Adherence to topical treatment in psoriasis: a systematic literature review. J Eur Acad Dermatol Venereol 2012; 26 Suppl 3:61-7. [PMID: 22512682 DOI: 10.1111/j.1468-3083.2012.04525.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Treatment adherence has been recognized as an important issue in the management of chronic diseases such as psoriasis. OBJECTIVE The aim of this work was to analyse data about topical treatment adherence in psoriasis. METHODS Systematic literature review (62 references) between 1980 and 2011 (database: PubMed, Embase and Cochrane; Mesh keywords: Patient Compliance [Mesh] OR Medication Adherence [Mesh] AND Psoriasis [Mesh]; limits: date of publication >1980, humans subjects, written in French or English, aged ≥ 19 years). Two parameters were evaluated: (i) the ratio of number of product applications performed vs. number of applications expected according to physician recommendations, (ii) the ratio of amount of product used vs. amount of product prescribed. RESULTS A total of 22 studies were selected. Nine studies reported on the frequency of topical treatment application in a real world setting. Five studies showed a frequency of applications varying between 50% and 60% of those expected. Because of the high variability in medication adherence assessment methods, the data could not be combined. Twelve articles reported on the frequency of topical treatment application in randomized controlled trials with adherence varying between 55% and 100%. Concerning the amount of product use, four studies showed patients applied between 35% and 72% of the recommended dose during a treatment period of 14 days to 8 weeks. The most frequently mentioned reasons for non-adherence to topical treatment were low efficacy, time consumption and poor cosmetic characteristics of topical agents. Patients experiencing adherence issues were significant younger, were men, had younger age at onset of psoriasis and had a higher self-assessed severity. To improve adherence, the following strategies were suggested: to give patients information about psoriasis, to recognize social impact, to give written instructions for use such as a care plan, to explain side effects of topical therapies, to choose treatment and its cosmetic properties in agreement with the patient. CONCLUSIONS Literature data about topical treatment adherence are heterogeneous and scarce. They confirm the limited topical treatment adherence in psoriasis in real life, much lower than what is reported in randomized controlled trials. Therapeutic education and clear instructions on the use of topical agents are necessary to improve adherence. Studies are needed to identify predictors of limited adherence and to identify interventions improving adherence to topical medications in psoriasis.
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Affiliation(s)
- S Devaux
- Dermatology Department, Paul Sabatier University, Toulouse, France.
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De Mozzi P, Alexandroff A, Johnston G. Updates from the British Association of Dermatologists 91st Annual Meeting, 5-7 July 2011, London, U.K. Br J Dermatol 2012; 167:232-9. [DOI: 10.1111/j.1365-2133.2012.11080.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kragballe K, Menter A, Lebwohl M, Tebbey PW, van de Kerkhof PCM. Long-term management of scalp psoriasis: perspectives from the international psoriasis council. J DERMATOL TREAT 2012; 24:188-92. [DOI: 10.3109/09546634.2012.681017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Paul C, Gallini A, Archier E, Castela E, Devaux S, Aractingi S, Aubin F, Bachelez H, Cribier B, Joly P, Jullien D, Le Maître M, Misery L, Richard MA, Ortonne JP. Evidence-based recommendations on topical treatment and phototherapy of psoriasis: systematic review and expert opinion of a panel of dermatologists. J Eur Acad Dermatol Venereol 2012; 26 Suppl 3:1-10. [DOI: 10.1111/j.1468-3083.2012.04518.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Halioua B. Observance: Définitions et méthodes de mesure: spécificités de l’observance des traitements topiques. Ann Dermatol Venereol 2012; 139 Suppl 1:S1-6. [DOI: 10.1016/s0151-9638(12)70101-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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