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PUVA and methotrexate therapy of psoriasis: how closely do dermatology departments follow treatment guidelines?
Author(s) -
BILSLAND D.J.,
RHODES L.E.,
ZAKI I.,
WILKINSON S.M.,
McKENNA K.E.,
HANDFIELDJONES S.E.,
AWILLIAMS R.E.
Publication year - 1994
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/j.1365-2133.1994.tb08495.x
Subject(s) - psoriasis , dermatology , puva therapy , medicine , methotrexate , surgery
Summary 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 topical 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.