Therapeutic benefits in atopic dermatitis care from the patients' perspective: results of the German national health care study 'Atopic Health'.

BACKGROUND/AIMS: Numerous therapies are recommended to treat atopic dermatitis. The German national health care study 'Atopic Health' generated nationwide data on the care situation from the patients' perspective. METHODS: Data for 1,678 adult patients were collected within a retrospective cohort study throughout the year 2010. Six scores to capture satisfaction with care, quality of life (Dermatology Life Quality Index, EQ-5D-VAS), therapeutic success and benefits (Patient Benefit Index) were analyzed using descriptive methods and analysis of variance. RESULTS: 82.1% of patients were highly satisfied with their treatment. Topical corticosteroids and climate therapies were associated with the best success ratings. Quality of life was moderately impaired (mean Dermatology Life Quality Index 8.5 ± 6.5). 88.4% of the patients indicated a relevant therapeutic benefit (Patient Benefit Index ≥ 1) with significantly better scores for topical immunomodulating therapies and climate therapies. CONCLUSION: The most frequently applied therapies presented pleasant success and benefit ratings, even if quality of life could be improved for more than one third of patients.

Allergies in Germany -- prevalence and perception by the public.

BACKGROUND: During the recent decades allergies have become more frequent all over the world. However, it is unclear how important the topic of allergies is for the general German population and how appropriately patients with allergies are treated. PATIENTS AND METHODS: A telephone survey was performed on a representative random sample of n = 1,004 adults in Germany. The survey was performed by the Forsa Institute for Social Research and Statistical Analysis, Berlin, Germany, in the period from 31 January to 2 February 2012. RESULTS: Of the interviewees 52% responded that the topic of allergies concerned them; in 33% actually an allergy had been diagnosed by a physician. The proportion of allergies in the population correlated with the level of school education and was higher among people with a higher educational status. No differences in allergy rates were found between Eastern and Western Germany. Among allergic persons, 53% reported to be burdened by their allergy, 48% suffered from impaired performance because of their allergic symptoms. Among people suffering from pollen allergy, only 28% received sublingual immune therapy, with which 70% were satisfied. While 58% practiced self-medication, only 21% of the allergic persons were treated with anti-allergic drugs during their allergy flares. CONCLUSIONS: Allergic diseases are a common, often burdensome problem in the German population, but nevertheless the medical treatment of people affected is still insufficient. The proportion of patients receiving sublingual immune therapy as causal treatment is comparatively low. Active steps are needed to improve the utilization behavior of patients, e. g. to take advice of an allergy specialist.

Drug supply for psoriasis - results from a national pharmacy network.

BACKGROUND: In Germany, drugs are to a large extent provided by pharmacies. Thus, investigations in pharmacies permit drug usage studies both on patients receiving prescribable drugs and using self-medication. The current study evaluated the quality of medical care, disease burden and spectrum of treatments for patients with psoriasis in a nationwide network of pharmacies. PATIENTS AND METHODS: A nationwide cross-sectional study was conducted in 61 pharmacies. Patients with psoriasis vulgaris who came to the pharmacy to obtain antipsoriatic drugs or basic ointments were consecutively recruited, interviewed and asked to complete a standardized questionnaire. The questionnaire focused on socio-demographic characteristics and prior therapies for psoriasis. Furthermore, data on the patient's treatment satisfaction, disease-related burden, and treatment adherence were evaluated. In addition, the proportion and significance of health care providers for psoriasis as well as the number of patients using self-medication were assessed. RESULTS: The data on 241 patients show a high and long-lasting disease-related burden. A high utilization of resources was found. Dermatologists were the most frequently consulted providers (reported by 77.1 % of patients), followed by general practitioners (10.4 %). 3.5 % of patients were using self-medication. Self-reported adherence with treatment was moderate (71.6 %). Patient satisfaction varied considerably and demonstrated the need for improvement. CONCLUSIONS: Psoriasis is a socio-economically relevant disease. Health care is provided primarily by dermatologists. Surveying patients in a national network of pharmacies is a unique and effective way of collecting relevant "real world" data. Selection biases related to the health care setting are minimized.

Efficacy, tolerability and patient benefit of ultrasound-assisted wound treatment versus surgical debridement: a randomized clinical study.

BACKGROUND: Low-frequency ultrasound has been shown to be an alternative to surgical wound debridement (WD) to stimulate wound healing; however, few data are available. OBJECTIVE: To compare the efficacy, tolerability and benefit of both wound treatment methods. METHODS: A monocentric prospective randomized-controlled clinical study assessing patient-reported outcomes and clinical efficacy of ultrasound-assisted wound treatment (UAW) compared to WD. RESULTS: In total, 67 patients were treated. Efficacy and tolerability were found to be good for both treatments, with 88% of UAW and 85.2% of WD patients experiencing more-than-minimal patient benefit. Quality of life improved significantly. Wound status improved and pain decreased in both groups. CONCLUSION: Compared to the gold standard (i.e. WD), UAW displays the same high efficacy, comparable patient benefit and improved quality of life. Both procedures are equally suitable for highly beneficial guideline-based treatment of chronic wounds.

Concordance of the Psoriasis Area and Severity Index (PASI) and patient-reported outcomes in psoriasis treatment.

A prospective observational study was conducted to analyze to what extent the Psoriasis Area and Severity Index (PASI) is correlated to patient reported outcomes (PRO). Data were collected on 93 outpatients with psoriasis prior to (t1) and after therapy (t2). A higher PASI score was associated with impaired Quality of Life (DLQI), however associations were only weak (R = 0.24 on t1 and R = 0.36 on t2). The average improvement in PASI score was correlated moderately highly with the change of DLQI (R = 0.50) as well as with the PBI (R = 0.45). The threshold values PASI-50 and PASI-75 were likewise positively associated with PRO, but they only incompletely reflect them: about half of the patients with PASI-50 did not see their expectations met (46.9%) or were not satisfied with the condition of the skin after treatment (56.3%). A quarter of these patients experienced no benefits from the therapy. Of the patients with PASI-75, 15.4% were not satisfied with the condition of their skin. In contrast, 36% of patients who did not attain PASI-50 specified a high level of treatment satisfaction. PASI and PRO are associated but based on different concepts. In addition to clinicial severity, patient-defined benefits should be implemented in the evaluation of psoriasis care.

Quality of medical care of patients with acne vulgaris in Germany--nationwide survey of pharmacy clients.

BACKGROUND: No empirical "real world" data on the health care of patients with acne vulgaris in Germany currently exist. The objective of this study was to get an informative basis of health care of patients with acne vulgaris in Germany, taking into account both doctor-prescribed medication and self-medication. PATIENTS AND METHODS: Surveying both medically and self-treated patients, n = 504 patients with acne vulgaris were interviewed in 48 pharmacies nationwide. In addition to socio-demographic data, the duration of illness, localization and therapy as well as patient-relevant outcomes such as patient benefit, psychological strain and markers of compliance were evaluated. The participation and significance of individual treatment providers were also evaluated. RESULTS: A large percentage of the patients found acne vulgaris to be burdensome. Despite the longstanding necessity of treatment and the chronic course of the illness, the treatment of acne vulgaris was deemed a rather satisfactory experience by most of those affected. Dermatologists were most frequently consulted for treatment. A great number of medicinal products were further acquired through self-medication or after consulting with a pharmacist. The medically regulated therapies predominantly complied with the latest guidelines. CONCLUSIONS: Acne vulgaris is a burdensome, socio-economically relevant illness, and dermatologists treat most cases in Germany. Surveying across a network of pharmacies offers a unique access to relevant treatment data. Selection effects, particularly by choice of doctors and self-medication, were minimized.

Does climate change affect the incidence of skin and allergic diseases in Germany?

BACKGROUND: Skin diseases have great socio-economic importance in Germany due to their high and in some cases still-increasing prevalence. Little attention has yet been paid to the influence of the change in climate on these diseases. OBJECTIVE: Clarify the evidence of the effects of climate change on the prevalence of skin diseases and allergies in Germany. METHODS: First, a theoretical model of the possible mechanisms and influence factors of climate and weather was created for different disease groups (skin malignancies, allergies, skin infections). Then, a systematic online and manual literature search was made for model-derived key words.The relevant publications were selected and evaluated according to a priori criteria. RESULTS: From a total of n = 31,221 hits, n = 320 publications remained for evaluation.Changes in the following parameters can be regarded as essential climatologic factors influencing the prevalence of skin and allergic diseases: temperature, UV radiation, precipitation/humidity, cloudiness, and general weather conditions.There were only a few original articles addressed to this topic. Most of them address recurring phenomena (especially levels of airborne pollen), UV radiation or ozone (and the ozone hole). Quantitative statements, prognosis models and climate scenarios have not yet been published for Germany with respect to skin diseases. CONCLUSION: Only few scientific articles on the relationship between climate changes and the prevalence of skin diseases have been published. They do not allow a reliable statement on future developments. The outlook for changes in prevalence requires further clarification using published climate models.