Adequacy of Care in patient with Psoriasis (ADECAP) Study
- Author:
Tan WC
;
Chan LC
;
Ong KP
;
Tan SS
;
Kweh MW
;
Jeffrey L
;
Kalaikumar N
- Publication Type:Journal Article
- Keywords:
Psoriasis, Standard of Care, Clinical Audit, Metabolic Syndrome
- From:Malaysian Journal of Dermatology
2011;26(-):12-17
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: Psoriasis is a chronic recurrent inflammatory skin disease and poses a lifelong
burden. Psoriasis is now considered a systemic inflammatory disease. Increasing epidemiological
studies have established the role of psoriasis as an independent risk factor in the development of
metabolic syndrome and its components. This has led to changes in standard of care
recommendations for patients with psoriasis. We conducted a clinical audit on “adequacy of care in
patient with psoriasis”.
Objective: To examine current trend of practice in the treatment of adults with psoriasis in
Dermatology clinic (tertiary referral centre), Penang Hospital. This study also aims to determine the
adequacy of care in psoriasis patients in general, and those on systemic agents in specific.
Method: A retrospective study examined all adult psoriasis patients who visited Dermatology
Clinic, Penang Hospital within 1st July - 31st July 2009. Only those who have been on follow-up for
at least 1 year were included in the study. Demographic characteristics, disease burden and details
of psoriasis management were documented and analysed. Standards were derived from
recommendations of the British Association of Dermatologists (BAD) and American Academy of
Dermatology (AAD).
Results: Of the 112 patients, 67 were males (59.8%). The mean age of patients was 48.8 years. Fifty
(44.6%) were Chinese, 35 Malay (31.3%), 26 Indians (23.2%) and 1 foreigner (0.9%). The mean
frequency of clinic visit was 8.2. Forty-seven patients required systemic agents to achieve better
disease control. Eighty-three (74.1%) patients were offered “Psoriasis Education Programme”.
Percentage of patients who had their severity scoring done by using the DLQI, BSA & Pain score
were 73.2%, 90.2% and 85.7% respectively. Only less than 50% of our patients were offered
“Metabolic Syndrome Risk Factors Screening”. Of those on systemic agents, only 87.2% and 46.8%
of patients, had their baseline and follow up blood investigations done respectively.
Conclusion: The care of psoriasis patients in Dermatology Clinic, Penang Hospital is still not
adequate. Particular areas of concern include blood monitoring for those on systemic agents and
screening for metabolic syndrome risk factors.
Remedial measures: Guidelines have been designed to create awareness and to educate doctors and
patients on psoriasis and its association with metabolic syndrome. This includes a flow chart / tables
to facilitate monitoring and screening of patients. Patients will be given pamphlets on the general
knowledge on psoriasis, treatments and the risk of co-morbidities.
