Treatment and referral patterns for psoriasis in United Kingdom primary care: a retrospective cohort study

Annals of Occupational and Environmental Medicine

Javaria Mona Khalid²  Gary Globe⁴  Kathleen M Fox¹  Dina Chau⁴  Andrew Maguire²  Chio-Fang Chiou³ 

[1] Strategic Healthcare Solutions, LLC, PO Box 543, Monkton, MD 21111, USA

[2] United Biosource Corporation, London, UK

[3] Janssen Global Services, Companies of Johnson & Johnson, New Jersey, USA

[4] Amgen Inc., Thousand Oaks, CA, USA

关键词: UK;    Referral patterns;    Psoriasis;    General practice;    Primary care;   

Others  :  814208
DOI  :  10.1186/1471-5945-13-9

 received in 2013-01-08, accepted in 2013-08-14,  发布年份 2013

【 摘 要 】

Background

In the UK, referrals to specialists are initiated by general practitioners (GPs). Study objectives were to estimate the incidence of diagnosed psoriasis in the UK and identify factors associated with GP referrals to dermatologists.

Methods

Newly diagnosed patients with psoriasis were identified in The Health Improvement Network (THIN) database between 01 July 2007-31 Oct 2009. Incidence of diagnosed psoriasis was calculated using the number of new psoriasis patients in 2008 and the mid-year total patient count for THIN in 2008. A nested case–control design and conditional logistic regression were used to identify factors associated with referral.

Results

Incidence rate of diagnosed adult psoriasis in 2008 was 28/10,000 person-years. Referral rate to dermatologists was 18.1 (17.3-18.9) per 100 person-years. In the referred cohort (N=1,950), 61% were referred within 30 days of diagnosis and their median time to referral was 0 days from diagnosis. For those referred after 30 days (39%, median time to referral: 5.6 months), an increase in the number of GP visits prior to referral increased the likelihood of referral (OR=1.87 95% CI:1.73-2.01). A prescription of topical agents such as vitamin D3 analogues 30 days before referral increased the likelihood of being referred (OR=4.67 95% CI: 2.78-7.84), as did corticosteroids (OR=2.45 95% CI: 1.45-4.07) and tar products (OR=1.95 95% CI: 1.02-3.75).

Conclusions

Estimates of the incidence of diagnosed adult psoriasis, referral rates to dermatologists, and characteristics of referred patients may assist in understanding the burden on the UK healthcare system and managing this population in primary and secondary care.

【 授权许可】

   
2013 Khalid et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Greaves MW, Weinstein GD: Treatment of psoriasis. N Engl J Med 1995, 332:581-588.
• [2]Conway P, Currie CJ: Descriptive epidemiology of hospitalisation for psoriasis. Curr Med Res Opin 2008, 24:3487-3491.
• [3]Gelfand JM, Weinstein R, Porter SB, Neimann AL, Berlin JA, Margolis DJ: Prevalence and treatment of psoriasis in the United Kingdom: a population-based study. Arch Dermatol 2005, 141:1537-1541.
• [4]Gelfand JM, Troxel AB, Lewis JD, et al.: The risk of mortality in patients with psoriasis: results from a population-based study. Arch Dermatol 2007, 143:1493-1499.
• [5]Horn EJ, Fox KM, Patel V, et al.: Association of patient-reported psoriasis severity with income and employment. J Am Acad Dermatol 2007, 57:963-971.
• [6]Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM: Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol 1999, 41:401-407.
• [7]Duque MI, Yosipovitch G, Chan YH, Smith R, Levy P: Itch, pain, and burning sensation are common symptoms in mild to moderate chronic venous insufficiency with an impact on quality of life. J Am Acad Dermatol 2005, 53:504-508.
• [8]Husted JA, Tom BD, Schentag CT, Farewell VT, Gladman DD: Occurrence and correlates of fatigue in psoriatic arthritis. Ann Rheum Dis 2009, 68:1553-1558.
• [9]Chan B, Hales B, Shear N, et al.: Work-related lost productivity and its economic impact on Canadian patients with moderate to severe psoriasis. J Cutan Med Surg 2009, 13:192-197.
• [10]National Health Services: Psoriasis. http://www.nhs.uk/Conditions/Psoriasis/Pages/NICE.aspx webcite
• [11]Smith CH, Anstey AV, Barker JN, et al.: British association of dermatologists' guidelines for biologic interventions for psoriasis 2009. Br J Dermatol 2009, 161:987-1019.
• [12]British National Formulary: Edition 59. http://www.bnf.org webcite
• [13]Huerta C, Rivero E, Rodriguez LA: Incidence and risk factors for psoriasis in the general population. Arch Dermatol 2007, 143:1559-1565.
• [14]The THIN database. http://www.ucl.ac.uk/pcph/research-groups-themes/THIN-pub/databases/pros-cons webcite
• [15]Lewis JD, Schinnar R, Bilker WB, Wang X, Strom BL: Validation studies of the health improvement network (THIN) database for pharmacoepidemiology research. Pharmacoepidemiol Drug Saf 2007, 16:393-401.
• [16]Chisholm J: The Read clinical classification. Br Med J 1990, 300:1467.
• [17]Maguire A, Blak BT, Thompson M: The importance of defining periods of complete mortality reporting for research using automated data from primary care. Pharmacoepidemiol Drug Saf 2009, 18:76-83.
• [18]Seminara NM, Abuabara K, Shin DB, et al.: Validity of the health improvement network (THIN) for the study of psoriasis. Br J Dermatol 2011, 164:602-609.
• [19]Townsend Deprivation Indexhttp://www.geog.soton.ac.uk/gen-refer/go3_142_c15p19819999snsw.html webcite
• [20]Edwards P, Robert I: Population adiposity and climate change. Int J Epidemiol 2009, 38:1137-1140.
• [21]Gillard SE, Finlay AY: Current management of psoriasis in the United Kingdom: patterns of prescribing and resource use in primary care. Int J Clin Pract 2005, 59:1260-1267.
• [22]Quality Outcomes Framework. http://www.qof.ic.nhs.uk webcite
• [23]British Association of Dermatologists: Treatment for moderate or severe psoriasis. http://www.bad.org.uk/site/866/default.aspx webcite
• [24]Langan SM, Seminara NM, Shin DB, et al.: Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the United Kingdom. J Invest Dermatol 2011.
• [25]Griffiths CE, Clark CM, Chalmers RJ, Li Wan Po A, Williams HC: A systematic review of treatments for severe psoriasis. Health Technol Assess 2000, 4(1):1-25.