Care of patients with psoriasis: an audit of U.K. services in secondary care.
BACKGROUND
Medical professionals require data about the structure and delivery of dermatological services in primary and secondary care in order to identify and tackle variations in standards and monitor the impact of healthcare reforms. The British Association of Dermatologists (BAD) commissioned an audit of the provision of care for patients with psoriasis.


OBJECTIVE
To assess the staffing and facilities in dermatology units in the U.K. with a focus on the provision of care for patients with psoriasis.


METHODS
Data were collected from 100 dermatology units in the U.K. for 1 year using a questionnaire and a web-based collection system.


RESULTS
Key results are as follows. Eighteen per cent (18/98) of units had fewer than 2.0 whole-time equivalent consultants and 20% had no specialist dermatology nurse. Only 23% of units collected diagnostic data on outpatients, and half were unable to supply details about the number of attendances for psoriasis. Seventy-seven units reported admitting patients to dedicated dermatology beds, general medical beds, or both; three-quarters of units had access to dedicated adult dermatology beds. Pharmacy services were not always available for dermatology patients. Only 21 units (21%) had dedicated clinics for patients with psoriasis and 56% of units lacked a clinical psychology service willing to accept adult dermatology patients; 59% (55/93) lacked psychological services for children. Fifty-five per cent had no systemic drug monitoring clinic. Phototherapy was run by dermatology nurses in 93% (88/95) of the units and by physiotherapists in 11% (10/94). Biologics for psoriasis were prescribed in 75% (73/97) of units and in 88% (64/73) of these the BAD guidelines for the use of biologics were known to be followed. Of the seventy-three units prescribing biologic therapies, 64% had a nurse trained in the assessment and administration of biologics, 71% had facilities for outpatient infusions (e.g. for infliximab) and 39% were restricted in prescribing biologic agents because of financial constraints. A quality-of-life score was either inadequately or never recorded in outpatient records in 81% of units, increasing to 88% for inpatient records. The Psoriasis Area and Severity Index score was inadequately or never recorded in 79% of outpatient records and 82% of inpatient records.


CONCLUSIONS
Units varied in their capacity to meet BAD guidelines and standards. Among the most significant deficiencies identified were a shortage of specialist dermatology nurses, treatment delivery by untrained nurses and financial constraints on the prescription of biologics for psoriasis. Gaps in data collection and record keeping jeopardize efforts to improve standards of care.
Eedy
D J
DJ
Department of Dermatology, Southern Health and Social Care Trust, 68 Lurgan Road, Portadown BT9 6NY, UK. David@DJEEDY.com
Griffiths
C E M
CE
Chalmers
R J G
RJ
Ormerod
A D
AD
Smith
C H
CH
Barker
J N W N
JN
Potter
J
J
Ingham
J
J
Lowe
D
D
Burge
S
S
D001688:Biological Products / Q000627:therapeutic use; D003253:Consultants / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000458:organization & administration*; D004363:Drug Utilization / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006302:Health Services Research / Q000379:methods; D006757:Hospital Units / Q000458:organization & administration*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008485:Medical Audit; D008499:Medical Records; D009741:Nursing Staff, Hospital / Q000706:statistics & numerical data; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000458:organization & administration; D011565:Psoriasis / Q000628:therapy*; D012017:Referral and Consultation; D014850:Waiting Lists; D000078329:Workforce
D001688:Biological Products