Dermatology Department, Nancy University Hospital, Bâtiment P Canton, 6 allée du Morvan, 54500 Vandœuvre-lès-Nancy, France.
Dermatology Department, Nancy University Hospital, Bâtiment P Canton, 6 allée du Morvan, 54500 Vandœuvre-lès-Nancy, France.
Ann Dermatol Venereol. 2024 Jun;151(2):103280. doi: 10.1016/j.annder.2024.103280. Epub 2024 May 22.
Despite the availability of a wide range of therapies for the systemic treatment of moderate to severe psoriasis, many psoriasis patients do not receive adequate treatment, suggesting that guidelines may not be correctly applied by physicians.
The aim of this study was to analyze data on physicians' implementation of, and reasons for noncompliance with, guidelines for the systemic treatment of moderate to severe psoriasis.
We conducted a systematic literature review according to the Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched the PubMed and Embase databases for studies on guideline adherence in the systemic treatment of moderate to severe psoriasis. All eligible articles were retrieved in full text and the relevant references of retrieved articles were included.
A total of 20 studies were selected. Four studies investigated knowledge of the guidelines, six studies examined their application, and five studies focused on the various barriers to implementation. Finally, five studies discussed ways to improve implementation. Several studies on the quality of psoriasis care have revealed discrepancies between the reality and the optimal care described in national and international guidelines.
Various barriers to implementation of recommendations exist, such as economic barriers, lack of dermatologic orientation towards, lack of knowledge of recommendations by other specialists, lack of applicability, and country- and practice-specific features (e.g., different benefit/risk ratios, different reimbursement rates and conditions). This review can help the everyday practitioner to better understand these barriers, which will have a direct impact on improving the quality of life of psoriasis patients.
尽管有多种疗法可用于中重度银屑病的系统治疗，但许多银屑病患者并未得到充分治疗，这表明医生可能没有正确应用指南。
本研究旨在分析医生在中重度银屑病的系统治疗中实施和不遵守指南的情况及原因。
我们根据系统评价和荟萃分析的首选项目（PRISMA）指南进行了系统文献回顾。我们在 PubMed 和 Embase 数据库中搜索了关于中重度银屑病系统治疗中遵医嘱情况的研究。检索到的所有合格文章均全文检索，并纳入检索文章的相关参考文献。
共选择了 20 项研究。四项研究调查了对指南的了解，六项研究考察了其应用情况，五项研究关注实施的各种障碍。最后，五项研究讨论了改善实施的方法。一些关于银屑病护理质量的研究表明，国家和国际指南中描述的现实情况与最佳护理之间存在差异。
存在各种实施建议的障碍，如经济障碍、缺乏对皮肤科的关注、其他专科医生对建议的了解不足、缺乏适用性以及国家和实践的具体特征（例如，不同的获益/风险比、不同的报销率和条件）。本综述可以帮助日常临床医生更好地理解这些障碍，这将直接影响改善银屑病患者的生活质量。
