Masip Montserrat, Pagès-Puigdemont Neus, López-Ferrer Anna, de Paz Héctor David, Serra-Baldrich Esther, Puig Lluís, Riera Pau
Pharmacy Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain.
Patient Prefer Adherence. 2024 Nov 16;18:2325-2335. doi: 10.2147/PPA.S489731. eCollection 2024.
This study aims to map the clinical pathway for psoriasis and atopic dermatitis (AD) in a tertiary hospital to better understand patient needs and experiences, thereby suggesting improvements in patient-centered care.
A mixed-method approach was utilised involving a literature review, a questionnaire for healthcare professionals (HCPs), and two focus groups (one with HCPs and the other with patients with psoriasis or AD). Ethical approvals were obtained, and informed consent was acquired from all participants.
Patients and HCPs identified significant delays in the pre-diagnosis phase, extending up to five years for psoriasis and three years for AD, adversely affecting the timely initiation of effective treatment. In addition, there were reported difficulties in obtaining appointments during flares, a lack of dermatologic emergencies, a need to increase human resources and physical space, and a need for telematic consultations for urgent cases. Discrepancies between HCPs' perceptions and patients' experiences highlighted unmet needs, particularly in primary care settings and emergency departments. Several strengths were also identified, including satisfactory experience in dermatology, the hospital's high level of specialisation in the management of complex patients, optimal communication between services, consideration of patient preferences, and proper advice on hospital pharmacy care and administration support of treatment and adherence monitoring.
The findings underscore the necessity for interventions to reduce wait times and improve treatment immediacy and effectiveness post-diagnosis. The insights from this study can direct enhancements in patient management and satisfaction for individuals with psoriasis and AD.
本研究旨在绘制一家三级医院中银屑病和特应性皮炎（AD）的临床路径，以更好地了解患者需求和体验，从而提出以患者为中心的护理改进建议。
采用混合方法，包括文献综述、针对医疗保健专业人员（HCPs）的问卷调查以及两个焦点小组（一个由HCPs组成，另一个由银屑病或AD患者组成）。获得了伦理批准，并获得了所有参与者的知情同意。
患者和HCPs指出在诊断前阶段存在显著延误，银屑病患者最长可达五年，AD患者最长可达三年，这对有效治疗的及时启动产生了不利影响。此外，据报告在病情发作期间预约困难、缺乏皮肤科急诊、需要增加人力资源和物理空间，以及需要为紧急病例提供远程会诊。HCPs的认知与患者体验之间的差异突出了未满足的需求，尤其是在初级保健机构和急诊科。还确定了几个优势，包括皮肤科的满意体验、医院在复杂患者管理方面的高度专业化、各科室之间的最佳沟通、对患者偏好的考虑，以及在医院药房护理、治疗管理支持和依从性监测方面的适当建议。
研究结果强调了采取干预措施以减少等待时间并提高诊断后治疗即时性和有效性的必要性。本研究的见解可为改善银屑病和AD患者的管理及满意度提供指导。
