Dermatology and medical law: the effect of legal issues on the treatment of patients in dermatological practices in southern Germany

Background: Usage of modern therapies in the treatment of chronic dermatological diseases has proven to be effective but associated with high costs. High therapy costs might raise legal issues and even lead to recourse claims. Objectives: To evaluate dermatologists' interests and knowledge in medical law and the occurrence of recourse claims, and to assess the impact of medical law on clinical practice. Materials & Methods: Dermatologists of the "Psoriasis-Praxisnetz Süd-West e.V." participated in a web-based questionnaire study investigating the relationship between medical law and usage of modern therapies. The questionnaire was separated in two sub-polls carried out from 11/2016 to 12/2016 and 02/2017 to 03/2017, respectively. The first addressed general topics of medical law and the second specific legal topics, particularly recourse claims. Results: Overall, 76 dermatologists participated in the first and 66 in the second sub-poll. In the first sub-poll, 27.6% of participants attended a seminar on medical law within the last 12 months. Furthermore, 28.8% of the participants of the second sub-poll already experienced a previous recourse claim, and 26.3% of those stated feeling confident or rather confident on legal topics. This proportion was lower among those who had not experienced a recourse claim (17.0%). Overall, 73.7% of those who had a previous recourse claim changed their prescription behaviour as a direct consequence thereof. Conclusion: The study demonstrates a close relationship between medical law issues and the prescription behaviour of dermatologists working in private practices in southern Germany. Regular legal education would thus be beneficial for patient-centred care.

Psoriasis and addiction: assessing mental health based on a cross-sectional study in Germany.

Psoriasis is a chronic skin disease with a high mental burden. Well-known comorbidities include depression, anxiety, as well as alcohol and tobacco addiction, however, there is barely any evidence on other addictions. The aim of this study was to estimate the prevalence of the six most common addictions among psoriasis patients in Germany and to determine associated clinical factors. Dermatologists working in four dermatological clinics and 32 practices across Germany recruited patients between September 2018 and November 2019. This cross-sectional study contained questionnaires on six addictions, depression, anxiety, and the Dermatology Life Quality Index (DLQI). In addition, scores for the Psoriasis Area and Severity Index (PASI) were obtained by physicians. Overall, 502 patients (43.4% women; mean age: 49.7 ± 14.6 years) were included. Positive addictions were found in 30.3% for daily smoking, 8.6% for alcohol, 1.2% for gambling, 3.8% for internet use, 3.6% for food, and 6.0% for drugs. Younger age was associated with a higher probability of addiction except for alcohol dependency. The PASI was only significantly associated with smoking. Addictions seem to be common among psoriasis patients. Further research should include comprehensive data and control groups, furthermore, standardised screenings and early referrals could represent first steps to improve people-centred healthcare for patients with psoriasis.

Documentation of psoriasis in routine care - expert consensus on a German data set.

BACKGROUND AND OBJECTIVES: Documenting patient data in psoriasis clinical practice can improve care, but standardized and transparent documentation is rare. The current project aimed to develop a data set for the documentation of psoriasis in daily practice. MATERIAL AND METHODS: In four online Delphi rounds and one in-person meeting, 27 psoriasis experts allocated variables to a standard, an optimal and an optional data set. Most of the questions were standardized. Open questions were included to allow for the provision of reasons and to enlarge the data sets. Furthermore, in the in-person meeting we considered a) patients' attitudes and b) dermatologists' information on the current usage and acceptability in Germany. RESULTS: The consensus approach resulted in a data set with 69 variables. The standard data set includes 20, the optimal data set 31 and the optional data set 18 variables. In summary, the data set can mainly be grouped into master data, general status and medical history data, medical history of psoriasis, status of psoriasis, diagnostics and comorbidity, therapies and patient-reported outcomes. CONCLUSIONS: The consensus recommendation of a standard, an optimal and an optional data set for routine care of psoriasis intends to be a decision-making aid and an orientation for both daily practice and further development of documentation systems.