Care of patients with psoriasis: an audit of U.K. services in secondary care

D J Eedy, C E M Griffiths, R J G Chalmers, A D Ormerod, C H Smith, J N W N Barker, J Potter, J Ingham, D Lowe, S Burge

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

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. OBJECTIVES: 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.
Original languageEnglish
Pages (from-to)557-564
Number of pages8
JournalBritish Journal of Dermatology
Volume160
Issue number3
Early online date16 Dec 2008
DOIs
Publication statusPublished - Mar 2009

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Secondary Care
Dermatology
Psoriasis
Patient Care
Biological Products
Outpatients
Nurses
Inpatients
Guidelines
Clinical Psychology
Biological Therapy
Pharmaceutical Services
Phototherapy
Health Care Reform
Drug Monitoring
Physical Therapists
Biological Factors
Standard of Care
Consultants
Prescriptions

Keywords

  • biological products
  • consultants
  • delivery of health care
  • drug utilization
  • health care surveys
  • health services research
  • hospital units
  • hospitalization
  • humans
  • medical audit
  • medical records
  • nursing staff, hospital
  • outpatient clinics, hospital
  • patient education as topic
  • primary health care
  • psoriasis
  • referral and consultation
  • waiting lists
  • audit
  • dermatology

Cite this

Eedy, D. J., Griffiths, C. E. M., Chalmers, R. J. G., Ormerod, A. D., Smith, C. H., Barker, J. N. W. N., ... Burge, S. (2009). Care of patients with psoriasis: an audit of U.K. services in secondary care. British Journal of Dermatology, 160(3), 557-564. https://doi.org/10.1111/j.1365-2133.2008.08987.x

Care of patients with psoriasis : an audit of U.K. services in secondary care. / Eedy, D J; Griffiths, C E M; Chalmers, R J G; Ormerod, A D; Smith, C H; Barker, J N W N; Potter, J; Ingham, J; Lowe, D; Burge, S.

In: British Journal of Dermatology, Vol. 160, No. 3, 03.2009, p. 557-564.

Research output: Contribution to journalArticle

Eedy, DJ, Griffiths, CEM, Chalmers, RJG, Ormerod, AD, Smith, CH, Barker, JNWN, Potter, J, Ingham, J, Lowe, D & Burge, S 2009, 'Care of patients with psoriasis: an audit of U.K. services in secondary care', British Journal of Dermatology, vol. 160, no. 3, pp. 557-564. https://doi.org/10.1111/j.1365-2133.2008.08987.x
Eedy DJ, Griffiths CEM, Chalmers RJG, Ormerod AD, Smith CH, Barker JNWN et al. Care of patients with psoriasis: an audit of U.K. services in secondary care. British Journal of Dermatology. 2009 Mar;160(3):557-564. https://doi.org/10.1111/j.1365-2133.2008.08987.x
Eedy, D J ; Griffiths, C E M ; Chalmers, R J G ; Ormerod, A D ; Smith, C H ; Barker, J N W N ; Potter, J ; Ingham, J ; Lowe, D ; Burge, S. / Care of patients with psoriasis : an audit of U.K. services in secondary care. In: British Journal of Dermatology. 2009 ; Vol. 160, No. 3. pp. 557-564.
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abstract = "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. OBJECTIVES: 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.",
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T2 - an audit of U.K. services in secondary care

AU - Eedy, D J

AU - Griffiths, C E M

AU - Chalmers, R J G

AU - Ormerod, A D

AU - Smith, C H

AU - Barker, J N W N

AU - Potter, J

AU - Ingham, J

AU - Lowe, D

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N2 - 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. OBJECTIVES: 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.

AB - 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. OBJECTIVES: 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.

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KW - consultants

KW - delivery of health care

KW - drug utilization

KW - health care surveys

KW - health services research

KW - hospital units

KW - hospitalization

KW - humans

KW - medical audit

KW - medical records

KW - nursing staff, hospital

KW - outpatient clinics, hospital

KW - patient education as topic

KW - primary health care

KW - psoriasis

KW - referral and consultation

KW - waiting lists

KW - audit

KW - dermatology

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JO - British Journal of Dermatology

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