Banchory Group Practice, Banchory, Scotland.
Curr Med Res Opin. 2011 Jan;27(1):239-49. doi: 10.1185/03007995.2010.541021. Epub 2010 Dec 13.
Scalp psoriasis is a chronic recalcitrant condition. An aging literature for topical treatments used in clinical practice and no treatment guidelines means there is no current gold standard for its management in Scotland. There are no Scottish data on the resources and costs of treatment of the scalp psoriasis patient.
Conduct a survey of Scottish healthcare professionals to understand how patients are typically managed to support the development of a model estimating the cost-effectiveness of a new treatment for moderately severe scalp psoriasis in Scotland.
Experts from primary and secondary care were invited to participate in an interview programme to collect information on the management of scalp psoriasis in Scotland. This was further informed by Scottish prescribing statistics. Simple descriptive statistics were performed.
Forty-three healthcare professionals (33 from primary care and ten in secondary care) completed the survey which illuminated national prescribing statistics. While an overall 72% response rate was achieved, representation from five of 14 Health Boards was not available. There was significant variation in stated patient pathways but some common themes. Most patients were treated initially with coal tar preparations and shampoos, then often progressing to topical potent corticosteroids. There was no consensus on the order patients might receive topicals thereafter although if referred for specialist review they would typically have been treated with three topicals in primary care first. Treatment in secondary care comprised application of topicals available in primary care or alternative preparations with nurse assistance to improve compliance. Phototherapy and systemic agents were not given to patients with scalp psoriasis alone. Study limitations are not considered to impact on the study observations.
There was a large variety in first-, second- and third-line agents in primary care in scalp psoriasis although our interview programme and prescribing data confirmed which treatments were most frequently prescribed. Treatment heterogeneity reflects the limitations in current therapies, paucity of evidence-based effectiveness data and lack of clinical guidelines. Experts agreed 'current standard practice' in Scotland was best described as an average across five plausible treatment pathways.
头皮银屑病是一种慢性难治性疾病。由于临床实践中使用的局部治疗方法的文献较为陈旧，且没有治疗指南，因此苏格兰目前尚无针对其管理的金标准。苏格兰没有关于头皮银屑病患者治疗资源和成本的相关数据。
对苏格兰的医疗保健专业人员进行调查，以了解患者的典型治疗方法，从而支持开发一种模型来评估一种新型中度严重头皮银屑病治疗方法在苏格兰的成本效益。
邀请初级和二级保健专家参加访谈计划，以收集有关苏格兰头皮银屑病管理的信息。该计划还参考了苏格兰的处方统计数据。进行了简单的描述性统计分析。
共有 43 名医疗保健专业人员（33 名来自初级保健，10 名来自二级保健）完成了调查，调查结果反映了全国的处方统计数据。尽管总体回复率达到了 72%，但仍有 14 个卫生委员会中的 5 个没有代表参与。患者的治疗途径存在显著差异，但也存在一些共同的主题。大多数患者最初接受煤焦油制剂和洗发水治疗，然后通常会转而使用强效局部皮质类固醇。尽管如果转诊接受专家评估，他们通常会先在初级保健中使用三种局部药物治疗，但对于接下来患者可能会接受哪种治疗，目前尚未达成共识。二级保健的治疗包括应用初级保健中可获得的局部药物或替代制剂，并由护士协助以提高患者的依从性。光疗和全身药物不适用于单独患有头皮银屑病的患者。研究局限性被认为不会影响研究观察结果。
尽管我们的访谈计划和处方数据证实了哪些治疗方法最常被开处方，但在头皮银屑病的初级保健中，一线、二线和三线药物的种类繁多。治疗的异质性反映了现有治疗方法的局限性、缺乏基于证据的有效性数据以及缺乏临床指南。专家们一致认为，苏格兰的“现行标准实践”最好描述为五种合理治疗途径的平均值。
