Measurement of healthcare quality in atopic dermatitis - development and application of a set of quality indicators.

BACKGROUND: Quality indicators are essential tools for the assessment of health care, in particular for guideline-based procedures. OBJECTIVE: Development of a set of indicators for the evaluation of process and outcomes quality in atopic dermatitis (AD) care. Application of the indicators to a cross-sectional study and creation of a global process quality index. METHODS: An expert committee consisting of 10 members of the German guideline group on AD condensed potential quality indicators to a final set of 5 outcomes quality and 12 process quality indicators using a Delphi panel. The outcomes quality and 7 resp. 8 process quality indicators were retrospectively applied to a nationwide study on 1678 patients with atopic dermatitis (AtopicHealth). Each individual process quality indicator score was then summed up to a global index (ranges from 0 [no quality achieved] to 100 [full quality achieved]) displaying the quality of health care. RESULTS: In total, the global process quality index revealed a median value of 62.5 and did not or only slightly correlate to outcomes quality indicators like the median SCORing Atopic Dermatitis (SCORAD; rp = 0.08), Dermatology Life Quality Index (DLQI; rp = 0.256) and Patient Benefit Index (PBI; rp = -0.151). CONCLUSION: Process quality of AD care is moderate to good. The healthcare process quality index does not substantially correlate to the health status of AD patients measured by 5 different outcomes quality indicators. Further research should include the investigation of reliability, responsiveness and feasibility of the proposed quality indicators for AD.

Willingness to pay and quality of life in patients with atopic dermatitis.

Atopic dermatitis (AD) is a frequent and burdensome disease. The objectives of this study were (1) to assess the willingness to pay (WTP) and quality of life (Qol) in AD patients and (2) to compare the results with data on other chronic skin diseases. To collect data, a non-interventional, cross-sectional nationwide postal survey on adult patients with clinically diagnosed AD was performed; socio-demographic data, clinical features/symptoms, WTP and QoL were recorded. WTP was assessed in three different approaches, including relative and absolute figures. Data from n = 384 AD patients (mean age 42.0, range 18-92, 69.8 % female) were analyzed. WTP for complete healing was on median 1,000 (average 11,884) and exceeded WTP in rosacea (median 500) but not in vitiligo (median 3,000). Mean Dermatology Life Quality Index (DLQI) was 8.5 (vitiligo 7.0; psoriasis 6.7; rosacea 4.3) and correlated with pruritus, xerosis and disturbed sleep. WTP and DLQI correlated only marginally (r s = 0.134, p = 0.01). In conclusion, AD patients show high WTP and markedly reduced QoL compared to other chronic skin diseases.

Topical treatment of tinea pedis using 6% coriander oil in unguentum leniens: a randomized, controlled, comparative pilot study.

BACKGROUND: The antifungal activity of coriander oil has already been demonstrated in vitro. OBJECTIVE: Evaluation of the efficacy and tolerability of 6% coriander oil in unguentum leniens in the treatment of interdigital tinea pedis. METHODS: Half-side comparative pilot study on subjects with symmetric, bilateral interdigital tinea pedis. Active drug and placebo control were applied twice daily on the affected areas, and follow-up visits were performed on days 14 and 28. RESULTS: 40 participants (mean age 52.5 years, 60% male) were included in the study. For 6% coriander oil in unguentum leniens, a highly significant improvement of the clinical signs (p < 0.0001) was observed during the entire observation period; the number of positive fungal cultures also tended to decrease (p = 0.0654). The tolerability of the tested substances was good. CONCLUSION: Coriander oil is effective and well tolerated in the treatment of interdigital tinea pedis.

[Antiinflammatory potential of seven plant extracts in the ultraviolet erythema test. A randomized, placebo-controlled study]. / Antiinflammatorische Wirksamkeit von 7 Pflanzenextrakten im Ultraviolett-Erythemtest. Eine randomisierte, placebokontrollierte Studie.

BACKGROUND: Phytotherapeutics are widely used in medicine. The aim of this study was the evaluation of the antiinflammatory potential of seven medical plant extracts using the ultraviolet- (UV)-erythema test. PATIENTS AND METHODS: Randomized, placebo-controlled study on 40 healthy subjects. Test areas on the upper back were irradiated with the 1.5 fold UV-B minimal erythema dose (MED). Formulations of Aloe vera, Chamomilla recutita, Hamamelis virginiana, Melissa officinalis, Mentha arvensis, Melaleuca alternifolia, Coriandrum sativum as well as 1% hydrocortisone acetate and 0.1% betamethasone valerate as positive controls and unguentum leniens as vehicle control were applied under occlusion on the irradiated areas and on non-irradiated area on the contralateral side. Photometric assessment of the erythema was performed before the application of the substances (t0), at 24 h (t1) and at 48 h (t2). RESULTS: Aloe vera, Chamomilla recutita, Melissa officinalis, Melaleuca alternifolia and Coriandrum sativum showed an antiinflammatory effect compared to UV-control and unguentum leniens. However, the results were only statistically significant for Aloe vera. All tested plant extracts were well tolerated. CONCLUSION: Aloe vera possesses an antiinflammatory effect on UV-induced erythemas.

Willingness to pay and quality of life in patients with rosacea.

BACKGROUND: Rosacea is a chronic inflammatory dermatosis affecting >2% of the population. Willingness to pay (WTP) is a well established method which reflects the individual burden of disease. OBJECTIVES: Evaluation of WTP and quality of life (QoL) in patients with rosacea. METHODS: Nationwide postal survey on adult patients with rosacea affiliated with the German rosacea patient advocacy group. WTP was evaluated by three standardized items and compared to historical data on vitiligo (n = 1023). QoL was assessed using the Dermatology Life Quality Index (DLQI). RESULTS: Data from n = 475 rosacea patients (79.9% women, mean age 56.3, range 26-90) were analysed. On average, patients were willing to pay € 2880 (median € 500) for complete healing compared with € 7360 (median € 3000) in vitiligo. Relative WTP was higher in women; the highest sums were registered for the age group 21-30 years. The extent of facial involvement predicted a higher relative WTP, whereas WTP decreased with the duration of symptoms and age. Mean DLQI total score was 4.3 compared to 7.0 in vitiligo. In rosacea, the highest values were observed in patients <30 years. Severe QoL reductions (DLQI>10) were less frequent (11%) than in vitiligo (24.6%). The correlation between WTP and DLQI was significant (e.g. r = 0.249, P = 0.000 for relative WTP). CONCLUSION: Rosacea patients show a moderate WTP and average QoL reduction is mild. WTP proved to be a valid tool to assess patients' burden of disease. Patient education and the development of effective treatment options might still improve patients' satisfaction.

[Etanercept in juvenile psoriasis]. / Etanercept in der Therapie der juvenilen Psoriasis.

BACKGROUND: With a prevalence of 0.71%, psoriasis represents one of the most frequent dermatoses in childhood. PATIENTS AND METHODS: Eight children with severe psoriasis who failed to respond to other therapy received a weight- adapted treatment with etanercept (0.8 mg/kg body) administered subcutaneously once weekly after latent tuberculosis had been excluded. Follow-up visits were at week 4 and 12, subsequently every 12 weeks. RESULTS: Mean age at the start of treatment was 11.8 (range 7-16), six patients were boys. Within three months, six patients reached Psoriasis Area and Severity Index (PASI) reduction of 75%. Two patients stopped use at week 12 because of ineffectiveness. Apart from local side reactions and minor infections, no adverse events were observed. CONCLUSION: In our case series, etanercept proved to be an efficient drug in juvenile psoriasis without serious adverse events. However, patient registries and further randomized, double-blinded control studies are crucial to evaluate long-term efficacy and safety of etanercept.