Barriers to guideline‐compliant psoriasis care: analyses and concepts

Abstract

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 patient's 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 physician's and on the patient's 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 physician's 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.

Guideline‐compliant prescription of biologicals and possible barriers in dermatological practices in Bavaria

“…The questionnaire enquiries addressed general data, information on the prescription scheme regarding the use of biologicals in moderate to severe psoriasis and chronic spontaneous urticaria and 16 potential barriers (Table ). The barrier subdivision by Eissing et al . which divides barriers into three groups (patients, physicians and external factors) was amended by adding one category which states a concern about biologicals not due to personal or educational deficits.…”

Addiction: an underestimated problem in psoriasis health care

“…However, this is contrasted by the fact that only a minor proportion of necessitous psoriasis patients actually receive these treatments . While this unsatisfactory fact might be explained partially by economical risk or by the behaviour of treating physicians, recently the personality of psoriasis patients themselves has become the focus of research for compliance and adherence . It is generally accepted that psoriasis is a complex disease and there are several comorbidities associated with it.…”

Topical medication utilization and health resources consumption in adult patients affected by psoriasis: findings from the analysis of administrative databases of local health units

“…This is consistent with previous findings,21 and since there was no direct measure of disease severity, the patients on topical treatments may have had limited disease or they may have used topical agents as adjunctive treatment and, therefore, may not have needed continuous treatment. Nevertheless, according to recently published evidence,22,23 psoriasis is a chronic disease that requires continuous treatment to achieve optimal control of inflammatory activity and to minimize skin involvement, despite the fact that disease severity may wax and wane.…”