Cameron H, Yule S, Moseley H, Dawe R S, Ferguson J
Photobiology Unit, Department of Dermatology, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, U.K.
Br J Dermatol. 2002 Nov;147(5):957-65. doi: 10.1046/j.1365-2133.2002.04860.x.
While most patients requiring phototherapy can attend for hospital-based out-patient ultraviolet (UV) B therapy, a significant number cannot attend because of geographical, work, economic and other reasons.
To determine whether there was a need for home phototherapy in the Tayside area and, if so, to establish protocols and then to assess if such a service would be workable.
Patients referred from dermatology out-patient clinics in Tayside for narrow-band UVB (TL-01) phototherapy completed a pilot questionnaire that was followed by a two-phase project. In phase 1, patients with psoriasis were trained to use the home phototherapy equipment (HoPE) within the hospital department under nursing supervision while a teaching package and protocols were developed. In phase 2, home phototherapy was made available for patient use in the community, supported by a specialist home phototherapy nurse. Waldmann UV100 home therapy units were used, with accurate dosimetry. Detailed treatment records were kept and questionnaires were used to assess acceptability and costs of therapy.
Fifty-two pilot questionnaires were completed. Forty-two per cent of respondents found hospital phototherapy inconvenient and 75% felt phototherapy at home would be helpful. In phase 1, seven of 10 patients trained to use the HoPE completed therapy with the HoPE unit alone, reaching minimal residual activity (MRA) or clearance in a median of 18 exposures (median dose 10.38 J cm-2). In phase 2, 32 courses of home phototherapy were given to 30 patients. Of 23 with psoriasis, 18 reached clearance or MRA in a median of 22.5 exposures (median dose 9.84 J cm-2). Although self-reported erythema rates appeared higher than expected, all post-treatment questionnaire respondents would choose home phototherapy over hospital therapy if required in the future.
UVB (TL-01) home phototherapy is a useful practical development that has fulfilled a need in our catchment area. Where appropriate training and support teams are available it appears to be similar in effectiveness to hospital therapy, to be safe and to be cost-effective for patients.
虽然大多数需要光疗的患者可以前往医院接受门诊紫外线（UV）B治疗，但由于地理、工作、经济和其他原因，仍有相当数量的患者无法前往。
确定泰赛德地区是否需要家庭光疗，如果需要，制定方案，然后评估这样一项服务是否可行。
从泰赛德地区皮肤科门诊转诊接受窄谱UVB（TL-01）光疗的患者完成一份试点问卷，随后开展一个两阶段项目。在第1阶段，银屑病患者在医院科室护理监督下接受使用家庭光疗设备（HoPE）的培训，同时制定教学资料和方案。在第2阶段，在社区为患者提供家庭光疗服务，由一名专业家庭光疗护士提供支持。使用Waldmann UV100家庭治疗设备，并进行精确的剂量测定。保存详细的治疗记录，并使用问卷评估治疗的可接受性和费用。
完成了52份试点问卷。42%的受访者认为医院光疗不方便，75%的受访者认为家庭光疗会有帮助。在第1阶段，10名接受使用HoPE培训的患者中有7名仅使用HoPE设备完成了治疗，在中位数为18次照射（中位剂量10.38 J/cm²）时达到最小残余活动度（MRA）或清除。在第2阶段，为30名患者提供了32个家庭光疗疗程。23名银屑病患者中，18名在中位数为22.5次照射（中位剂量9.84 J/cm²）时达到清除或MRA。虽然自我报告的红斑发生率似乎高于预期，但所有接受治疗后问卷调查的受访者表示，如果未来需要，他们会选择家庭光疗而非医院治疗。
UVB（TL-01）家庭光疗是一项有益的实际进展，满足了我们服务区域的需求。在有适当培训和支持团队的情况下，它在有效性方面似乎与医院治疗相似，对患者来说是安全且具有成本效益的。
