Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
J Eur Acad Dermatol Venereol. 2016 Apr;30(4):569-75. doi: 10.1111/jdv.13452. Epub 2015 Nov 4.
Despite the availability of effective therapeutics and evidence-based treatment guidelines, a substantial proportion of patients with moderate-to-severe psoriasis does not receive appropriate care. This under-provision of health care may cause further worsening of health, remarkable limitations of the patient's quality of life, and indirect costs for the health care system. In order to provide guideline-compliant care for every psoriasis patient, it is important to identify barriers obstructing optimal care. Studies have identified various barriers on the physician's and on the patient's side; however, respective studies approached only single barriers, and not all of them in the context of psoriasis. Other publications that describe barriers systematically did not focus on psoriasis either. The objective of this literature review was to identify barriers and facilitators, based on studies analysing quality of care and single barriers, resulting in a comprehensive model of causal factors. Our analyses revealed three categories of barriers - patient-related, physician-related and external factors: On the patient side, we found non-adherence to therapies to be an important barrier, often in close association with psychiatric factors. Barriers on the physician's side predominantly are incomplete knowledge of the guidelines as well as the complexity of psoriasis comorbidity. In some countries, payment for patients with complex disease status is poor and inconsistent reimbursement regulations potentially interfere with optimal care. The current analysis indicates that most barriers are interdependent. Thus, measures approaching related barriers simultaneously are required. To improve care for psoriasis patients, further studies systematically addressing all potentially relevant barriers in conjoint are needed.
尽管有有效的治疗方法和基于证据的治疗指南，但相当一部分中重度银屑病患者得不到适当的护理。这种医疗服务的不足可能会导致健康状况进一步恶化，患者生活质量显著受限，并给医疗保健系统带来间接成本。为了为每一位银屑病患者提供符合指南的护理，重要的是要确定阻碍最佳护理的障碍。研究已经确定了医生和患者方面的各种障碍；然而，各自的研究只涉及单一障碍，而不是所有障碍都与银屑病有关。其他系统描述障碍的出版物也没有关注银屑病。本文献综述的目的是根据分析护理质量和单一障碍的研究，确定障碍和促进因素，从而建立一个因果因素的综合模型。我们的分析揭示了三类障碍 - 患者相关、医生相关和外部因素：在患者方面，我们发现不遵守治疗方案是一个重要的障碍，通常与精神因素密切相关。医生方面的障碍主要是对指南的不完全了解以及银屑病合并症的复杂性。在一些国家，对病情复杂的患者的付费情况较差，而不一致的报销规定可能会干扰最佳护理。目前的分析表明，大多数障碍是相互依存的。因此，需要同时采取措施来解决相关的障碍。为了改善银屑病患者的护理，需要进一步研究系统地解决所有潜在的相关障碍。
