Nicole Zander

Barriers to guideline-compliant psoriasis care: analyses and concepts

Despite the availability of effective therapeutics and evidence‐based treatment guidelines, a substantial proportion of patients with moderate‐to‐severe psoriasis does not receive appropriate care. This under‐provision of health care may cause further worsening of health, remarkable limitations of the patients quality of life, and indirect costs for the health care system. In order to provide guideline‐compliant care for every psoriasis patient, it is important to identify barriers obstructing optimal care. Studies have identified various barriers on the physicians and on the patients side; however, respective studies approached only single barriers, and not all of them in the context of psoriasis. Other publications that describe barriers systematically did not focus on psoriasis either. The objective of this literature review was to identify barriers and facilitators, based on studies analysing quality of care and single barriers, resulting in a comprehensive model of causal factors. Our analyses revealed three categories of barriers – patient‐related, physician‐related and external factors: On the patient side, we found non‐adherence to therapies to be an important barrier, often in close association with psychiatric factors. Barriers on the physicians side predominantly are incomplete knowledge of the guidelines as well as the complexity of psoriasis comorbidity. In some countries, payment for patients with complex disease status is poor and inconsistent reimbursement regulations potentially interfere with optimal care. The current analysis indicates that most barriers are interdependent. Thus, measures approaching related barriers simultaneously are required. To improve care for psoriasis patients, further studies systematically addressing all potentially relevant barriers in conjoint are needed.

Association of atopy and tentative diagnosis of skin cancer - results from occupational skin cancer screenings

The relationship between atopic conditions and carcinoma of the skin has been described inconsistently. Population‐based data providing information on atopic diseases as well as on skin cancer are sparse.

Analysis of patients’ willingness to be mobile, taking into account individual characteristics and two exemplary indications: Patients‘ willingness to be mobile

With respect to health care planning, it is commonly assumed that patients consult the nearest physician. In reality, however, patients frequently accept greater efforts/expenses than necessary to see a physician. The objective of the present study was to determine under which circumstances patients were willing to accept additional efforts/expenses, and which role sociodemographic and clinical characteristics play in this regard.

Prevalence, predictors and comorbidity of dry skin in the general population

Dry skin is a frequent and multifaceted condition which can be associated with skin irritation, itch, patient discomfort and manifest skin disease. In spite of being frequent, little is known about the epidemiology of dry skin in the population.

Cost-of-illness of psoriasis - results of a German cross-sectional study

Though psoriasis poses a substantial chronic socio‐economic burden, few studies have addressed the economic impact in Germany.

Was ist Schuppenflechte? - Wahrnehmung und Bewertung der Psoriasis in der deutschen Bevölkerung: Wahrnehmung der Psoriasis in der deutschen Bevölkerung

Die Versorgung der Psoriasis vulgaris nimmt in der Dermatologie einen wichtigen Stellenwert ein. Im Zuge der WHO‐Resolution 2014 und des WHO Global Reports 2016 hat die öffentliche Aufmerksamkeit für die Psoriasis zugenommen. Unklar ist, wie Psoriasis in der Allgemeinbevölkerung wahrgenommen wird. Ziel ist die Erfassung der Wahrnehmung und Bewertung von Psoriasis in der Bevölkerung.

Validity and feasibility of the wound-QoL questionnaire on health-related quality of life in chronic wounds

Chronic wounds have a major socioeconomic impact due to their frequency, chronicity, and societal costs. Patients experience substantial quality of life (QoL) impairments. The use of questionnaires for a continuous assessment of QoL and resulting interventions to improve the situation of the individual are an important cornerstone of a guideline‐based wound care. The aim of this study was to investigate the validity of the Wound‐QoL questionnaire. Patients with chronic wounds from two different centers were included in the prospective study. All patients completed the Wound‐QoL and two other QoL questionnaires (European Quality of Life‐5 Dimensions, EQ‐5D, and Freiburg Life Quality Assessment for wounds, FLQA‐wk) at baseline and at two more time points (4 and 8 weeks, respectively). Wound status was defined with an anchor question. Two hundred and twenty‐seven patients (48.5% women) participated in the study. Mean age was 66.9 years (range 17–96, median 69.5). Indications were venous leg ulcers (40.1%), pyoderma gangraenosum (14.1%), diabetic or ischemic foot ulcers (5.3%), pressure ulcers (2.6%), and other etiologies (30.0%). The Wound‐QoL showed good internal consistency, with high Cronbachs alpha in all the subscales and in the global scale in all time points (>0.8). Convergent validity was satisfactory since there were significantly (p ≤ 0.001) good correlations with the EQ‐5D (range = 0.5–0.7) and FLQA‐wk global score (r > 0.8) at every time point. Responsiveness was high, too. The Wound‐QoL is a simple, valid tool for the longitudinal assessment of QoL in patients with chronic wounds. This questionnaire is suitable for use in clinical trials, quality of care studies and clinical routine.

Development and validation of the Patient Benefit Index for peripheral arterial disease

Background The aim of this study was to develop and validate a specific Patient Benefit Index (PBI) version for the treatment of peripheral arterial disease (PAD). Patients and methods A non-interventional longitudinal development study was conducted. The first phase comprised a qualitative pre-study with n = 50 patients, in which the PBI was adapted for peripheral arterial disease. The resulting Patient Benefit Index for peripheral arterial disease (PBI-PAD) was validated in the second phase at two points of measurement. The total PBI-PAD score was calculated by weighting item-wise the achievement of treatment goals with the initially assessed needs. Feasibility, internal consistency, and construct validity were analysed and the generic three level version of the EuroQol five-dimensional questionnaire (EQ-5D-3L) and the disease-specific instrument Vascular Quality of Life Questionnaire (VascuQoL) were used for convergent validation. Results In the pre-study, the PBI-PAD, consisting of 12 items, was developed. N = 103 patients participated in the main study. At T2, data were available for n = 57 patients. Mean age was 71.0 years ± 9.1 and 66.7 % of the participants were male. The amount of missing values of the PBI-PAD score was low (< 4.0 %) and no relevant floor effects were observed. Both parts of the PBI (needs at T1 and benefits at T2) were internally consistent with Cronbach’s alpha > 0.7. PBI-PAD total score correlated significantly with the T2-T1-differences of the EuroQol-visual analogue scale (EQ VAS) (r = 0.4, p = 0.007) and the Vascular Quality of Life Questionnaire (r = 0.5, p < 0.001). Conclusions The PBI-PAD is a feasible, internally consistent, and valid instrument to assess patient-relevant benefits in PAD patients receiving minimally invasive treatment or surgical procedures. It can be recommended for use in routine care as well as in clinical studies.

What is psoriasis? - Perception and assessment of psoriasis among the German population: Perception of Psoriasis in the German Population

Delivery of health care to psoriasis patients plays an important role in the field of dermatology. Following the 2014 WHO resolution and the 2016 WHO global report, there has been an increase in the awareness of psoriasis among the general public. However, the perception of psoriasis by the general population remains unclear. The goal of the present study was to investigate the perception and assessment of psoriasis among the German population.

Analyse der Mobilitätsbereitschaft von Patienten unter Berücksichtigung individueller Merkmale und zweier Beispielindikationen: Mobilitätsbereitschaft von Patienten

In der Versorgungsplanung wird davon ausgegangen, dass Patienten den nächstgelegenen Arzt aufsuchen. Die Praxis zeigt jedoch, dass beim Arztbesuch oftmals ein höherer Aufwand in Kauf genommen wird, als notwendig. Es soll der Frage nachgegangen werden, unter welchen Umständen ein Patient einen Mehraufwand in Kauf nimmt und welchen Einfluss soziodemographische und klinische Merkmale haben.