Department of Dermatology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.
J Am Acad Dermatol. 2012 Sep;67(3):363-72. doi: 10.1016/j.jaad.2011.08.023. Epub 2011 Oct 19.
Non-adherence rates are high among patients with psoriasis, partly because of discordance between recommended treatments and individual preferences.
Our aim was to assess the impact of comorbidities on patients' preferences for psoriasis treatments.
A computer-based conjoint analysis experiment was conducted to analyze preferences of patients with psoriasis (N = 163) for treatment outcome attributes (probability, magnitude and duration of benefit; probability, severity and reversibility of side effects) and process attributes (treatment location, frequency, duration, delivery method, individual cost). The impact of comorbidities (psoriatic arthritis, cardiovascular disease, diabetes, and depression) on relative importance scores of each attribute was assessed by analyses of variance, post hoc test, and multivariate regression analysis.
Among the participants included (58.9% males, mean age 49.3 yrs), 27% suffered from psoriatic arthritis, 13.5% from cardiovascular disease, 8% from diabetes, and 12.9% from depression. Preferences for treatment attributes varied significantly depending on comorbidities. Participants with psoriatic arthritis cared most about the probability of benefit (β 0.166; P = .037), whereas those participants with cardiovascular disease were highly concerned about the probability of side effects (β 0.179; P = .046). For participants with depression, treatment duration (β 0.163; P = .047), and individual cost (P = .023) were highly important.
Only patients with moderate and severe psoriasis treated at a university medical center were included.
Integrating patients' preferences into shared decision-making may facilitate treatment adherence and optimize outcomes. Addressing patients' comorbidities, particularly depression, may be a currently neglected opportunity to improve care.
银屑病患者的不依从率很高，部分原因是推荐的治疗方法与个体偏好之间存在差异。
我们旨在评估合并症对患者银屑病治疗偏好的影响。
采用计算机基础联合分析实验，分析 163 例银屑病患者对治疗结局属性（获益的可能性、程度和持续时间；副作用的可能性、严重程度和可逆性）和过程属性（治疗地点、频率、持续时间、给药方式、个体成本）的偏好。采用方差分析、事后检验和多元回归分析评估合并症（银屑病关节炎、心血管疾病、糖尿病和抑郁症）对各属性相对重要性评分的影响。
在纳入的参与者中（58.9%为男性，平均年龄 49.3 岁），27%患有银屑病关节炎，13.5%患有心血管疾病，8%患有糖尿病，12.9%患有抑郁症。治疗属性的偏好因合并症而有显著差异。患有银屑病关节炎的参与者最关心获益的可能性（β0.166；P=0.037），而患有心血管疾病的参与者则非常关注副作用的可能性（β0.179；P=0.046）。对于患有抑郁症的参与者，治疗持续时间（β0.163；P=0.047）和个体成本（P=0.023）非常重要。
仅纳入了在大学医学中心接受中重度银屑病治疗的患者。
将患者的偏好纳入共同决策可能有助于提高治疗依从性并优化治疗效果。解决患者的合并症，特别是抑郁症，可能是改善护理的一个当前被忽视的机会。
