Katugampola R P, Hongbo Y, Finlay A Y
Department of Dermatology, Wales College of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK.
Br J Dermatol. 2005 Jun;152(6):1256-62. doi: 10.1111/j.1365-2133.2005.06576.x.
Clinical decisions over psoriasis are based on many factors. Patients' quality of life (QOL) is not directly related to disease severity alone as judged by physical signs, so decisions should not be based on physical assessments alone. This is increasingly important as new potent biological therapies become available.
This study aimed to determine whether clinicians' routine decisions in psoriasis correlate with patient-rated QOL.
Over 35 weeks all 687 outpatient psoriasis consultations by 13 clinicians were included. Each patient received a Dermatology Life Quality Index (DLQI) questionnaire following their consultation. Case notes were analysed to assign management decisions taken by clinicians to one of 11 categories. Patient-rated DLQI was correlated with the type of management decision.
Three hundred and eighty-three completed DLQI questionnaires were analysed. Within the 'no change to main type of therapy' group the mean DLQI for patients not changing the potency, dose or frequency of main treatment was 8.9. For patients in whom the potency, dose or frequency of main treatment was increased, the mean DLQI was 11.9. For patients in whom the potency, dose or frequency of main treatment was decreased, the mean DLQI was 6.2. Major management decisions were associated with a high mean DLQI such as change of topical therapy (11.2), topical to systemic therapy (14.8), change of systemic therapy (16.7), starting photo(chemo)therapy (13) and requiring hospital admission (14.4). By contrast, patients discharged reported low DLQI values (mean 4.0). The cohort of patients in whom a decision was taken to start day treatment had a surprisingly low mean DLQI of 8.6. Significant differences in mean DLQI were seen in the cohorts classified by type of management decision. For example, when the mean DLQI values in each cohort were compared (Mann-Whitney U-test), significant differences were seen between the cohorts in whom treatment was increased in potency, dose or frequency, compared with the cohorts whose treatment was unchanged (P < 0.05) or decreased (P < 0.01) or who were discharged from clinic (P < 0.01).
In psoriasis there is a relationship between the type of management decision and the patient-rated QOL. However, there is a very wide score scatter for each management decision, challenging the appropriateness of some clinical decisions.
银屑病的临床决策基于多种因素。患者的生活质量（QOL）并非仅与通过体征判断的疾病严重程度直接相关，因此决策不应仅基于体格检查。随着新型强效生物疗法的出现，这一点变得愈发重要。
本研究旨在确定临床医生对银屑病的常规决策是否与患者自评的生活质量相关。
在35周内，纳入了13名临床医生进行的所有687例门诊银屑病会诊。每位患者在会诊后均接受了皮肤病生活质量指数（DLQI）问卷。分析病历以将临床医生做出的管理决策归为11类中的一类。患者自评的DLQI与管理决策类型相关。
分析了383份完整的DLQI问卷。在“主要治疗类型无变化”组中，主要治疗的强度、剂量或频率未改变的患者的平均DLQI为8.9。主要治疗的强度、剂量或频率增加的患者，平均DLQI为11.9。主要治疗的强度、剂量或频率降低的患者，平均DLQI为6.2。主要管理决策与较高的平均DLQI相关，如局部治疗的改变（11.2）、从局部治疗改为全身治疗（14.8）、全身治疗的改变（16.7）、开始光（化）疗（13）以及需要住院（14.4）。相比之下，出院患者的DLQI值较低（平均4.0）。被决定开始日间治疗的患者队列的平均DLQI出人意料地低，为8.6。根据管理决策类型分类的队列中，平均DLQI存在显著差异。例如，当比较每个队列的平均DLQI值时（曼-惠特尼U检验），主要治疗的强度、剂量或频率增加的队列与治疗未改变（P < 0.05）或降低（P < 0.01）的队列或从诊所出院的队列（P < 0.01）之间存在显著差异。
在银屑病中，管理决策类型与患者自评的生活质量之间存在关联。然而，每种管理决策的评分分散度都非常大，这对一些临床决策的合理性提出了挑战。
