Health services research the example of atopic dermatitis

Abstract

Within the past years, health services research projects have analyzed critically the management of atopic eczema (AE) in routine care, quantified the utility of controlling severe AE, and introduced an international standardization of core outcome measures for AE. With a prevalence of 16%, AE is the most frequent chronic condition at all among children and adolescents seeking medical care. Despite lower prevalence in adults, about 60% of patients with AE in routine care are adults. There is a clinically relevant comorbidity of AE and psychiatric conditions. Independent of patient's age and physician's medical discipline topical corticosteroids dominate outpatient treatment of AE. However, there is considerable heterogeneity in the management of AE between treating physicians. Despite a lack of clinical trials, systemic corticosteroids are most frequently prescribed for severe AE. In contrast, cyclosporine only plays a minor role in routine care of severe AE although its efficacy is well-documented in trials. This observation stimulated a head-to-head trial that indicated superiority of cyclosporine over prednisolone for severe adult AE. The control of severe AE has high priority from the perspective of the general population and from the patients' perspective. Competence of the treating physician, disease severity and patient's competence to adjust treatment to disease activity are the main determinants of patient satisfaction. Aiming for a better comparability of clinical trials and better translation of trial evidence into clinical practice, we conducted a Delphi exercise including clinical experts from 11 countries, editors of international dermatological journals, regulatory agencies, and patient representatives. The preliminary core set of outcome domains for eczema trials as defined by the panel included symptoms, physician-assessed clinical signs, and a measurement for long-term control of flares. Symptoms such as itching should be regularly assessed in clinical practice. The presented studies indicate that health services research not only describes and critically analyzes the effectiveness of routine clinical care, but is also translational research in that it may stimulate clinical trials and generate new, clinically relevant hypotheses for experimental studies.

Therapeutic Benefits in Atopic Dermatitis Care from the Patients' Perspective: Results of the German National Health Care Study ‘Atopic Health'

“…This may be due to long-term clinical experience with dosage and handling of adverse effects. Unfortunately, validated analyses are rare, with only one placebo-controlled multicenter trial by Schmitt et al [52] comparing prednisolone vs. cyclosporine and showing long-term therapeutic superiority of cyclosporine [16,52,53]. …”

Measurement of disease severity in dermatology

“…Dies bedeutet in der Konsequenz, dass die effektivste Therapieform aufgrund der fehlenden standardisierten Operationalisierung und Messung der Erkrankungsschwere nicht identifiziert [16] und damit einhergehend eine evidenzbasierte Patientenversorgung nicht umgesetzt werden kann. Daraus resultierend sind Empfehlungen aus der klinischen Forschung für die klinische Praxis nicht oder nur teilweise möglich [17]. Ein in diesem Zusammenhang relevantes Problem sind die von Charman et al…”