Assuntos
Verrugas/terapia , Anti-Infecciosos/uso terapêutico , Antineoplásicos/uso terapêutico , Cantaridina/uso terapêutico , Ácidos Carboxílicos/uso terapêutico , Proliferação de Células/efeitos dos fármacos , Terapias Complementares/métodos , Crioterapia/métodos , Fármacos Dermatológicos/uso terapêutico , Quimioterapia Combinada , Humanos , Hipertermia Induzida/métodos , Imunoterapia/métodos , Ceratolíticos/uso terapêutico , Terapia a Laser/métodos , Fotoquimioterapia/métodos , Oclusão Terapêutica/métodos , Vitaminas/uso terapêutico , Verrugas/diagnósticoRESUMO
Following publication of treatment guidelines for patients with psoriasis, a six-centre audit was undertaken to assess current therapeutic practice for two second-line treatments, PUVA and methotrexate. The audit consisted of random sampling of casenotes by external auditors from a paired dermatology department, and assessment by questionnaire. One hundred and eight PUVA and 118 methotrexate casenotes were audited. The commonest indications for treatment were: (a) failure of tropical therapy--PUVA (mean 81% of casenotes), methotrexate (84%); (b) repeated hospital admissions--PUVA (16%), methotrexate (25%). For both PUVA and methotrexate, some aspects of treatment were well documented: PUVA--psoralen dosage (91%), response to PUVA (89%), cumulative lifetime UVA dosage (81%); methotrexate--pretreatment assessment of full blood count (91%), urea and electrolytes (85%), liver function tests (84%). For other aspects documentation was less complete: PUVA--no documentation of presence/absence of skin cancer history (66%), note of photoactive drugs (32%); methotrexate--concurrent medication (69%), history of presence/absence of liver disease (36%). Another aspect which was poorly documented in both PUVA and methotrexate notes was whether advice on contraception/fertility had been given. There was no indication in 29 of 32 casenotes of females of child-bearing age receiving PUVA, and 52 of 63 case notes of relevant patients on methotrexate. This project has demonstrated that formal, multicentre audit based on published guidelines is a practical proposition.