Clinical management decisions are related to the impact of psoriasis on patient-rated quality of life
- 22 June 2005
- journal article
- Published by Oxford University Press (OUP) in British Journal of Dermatology
- Vol. 152 (6), 1256-1262
- https://doi.org/10.1111/j.1365-2133.2005.06576.x
Abstract
Background Clinical decisions over psoriasis are based on many factors. Patients' quality of life (QOL) is not directly related to disease severity alone as judged by physical signs, so decisions should not be based on physical assessments alone. This is increasingly important as new potent biological therapies become available. Objectives This study aimed to determine whether clinicians' routine decisions in psoriasis correlate with patient-rated QOL. Patients and methods Over 35 weeks all 687 outpatient psoriasis consultations by 13 clinicians were included. Each patient received a Dermatology Life Quality Index (DLQI) questionnaire following their consultation. Case notes were analysed to assign management decisions taken by clinicians to one of 11 categories. Patient-rated DLQI was correlated with the type of management decision. Results Three hundred and eighty-three completed DLQI questionnaires were analysed. Within the ‘no change to main type of therapy’ group the mean DLQI for patients not changing the potency, dose or frequency of main treatment was 8·9. For patients in whom the potency, dose or frequency of main treatment was increased, the mean DLQI was 11·9. For patients in whom the potency, dose or frequency of main treatment was decreased, the mean DLQI was 6·2. Major management decisions were associated with a high mean DLQI such as change of topical therapy (11·2), topical to systemic therapy (14·8), change of systemic therapy (16·7), starting photo(chemo)therapy (13) and requiring hospital admission (14·4). By contrast, patients discharged reported low DLQI values (mean 4·0). The cohort of patients in whom a decision was taken to start day treatment had a surprisingly low mean DLQI of 8·6. Significant differences in mean DLQI were seen in the cohorts classified by type of management decision. For example, when the mean DLQI values in each cohort were compared (Mann–Whitney U-test), significant differences were seen between the cohorts in whom treatment was increased in potency, dose or frequency, compared with the cohorts whose treatment was unchanged (P < 0·05) or decreased (P < 0·01) or who were discharged from clinic (P < 0·01). Conclusions In psoriasis there is a relationship between the type of management decision and the patient-rated QOL. However, there is a very wide score scatter for each management decision, challenging the appropriateness of some clinical decisions.Keywords
This publication has 33 references indexed in Scilit:
- The dermatology life quality index (DLQI) provides qualitatively different information from the pasiJournal of the American Academy of Dermatology, 2004
- A quantitative definition of severe psoriasis for use in clinical trialsJournal of Dermatological Treatment, 2004
- Development of the PSORIQoL, a psoriasis-specific measure of quality of life designed for use in clinical practice and trialsBritish Journal of Dermatology, 2003
- Intramuscular Alefacept Improves Health-Related Quality of Life in Patients with Chronic Plaque PsoriasisDermatology, 2003
- Willingness to pay and time trade-off: sensitive to changes of quality of life in psoriasis patients?British Journal of Dermatology, 2003
- Psychological influences in psoriasisClinical and Experimental Dermatology, 2001
- Dermatology Life Quality Index: Data from Danish Inpatients and OutpatientsActa Dermato-Venereologica, 2000
- Quality of life of psoriasis patientsJournal of the European Academy of Dermatology and Venereology, 2000
- Assessing the preferences of patients with psoriasis. A quantitative, utility approachArchives of Dermatology, 1995
- Quality of life in dermatology and the EADVJournal of the European Academy of Dermatology and Venereology, 1994