Research article released on the health care and needs of Italian psoriasis patients

BMC Public Health

Research article

Analysis of health care and actual needs of patients with psoriasis: a survey on the Italian population

Emma Altobelli*1, Mara Maccarone2, Reimondo Petrocelli1, Ciro Marziliano1, Alberto Giannetti3, Ketty Peris4 and Sergio Chimenti5

Address: 1Department of Internal Medicine and Public Health, University of L’Aquila, Coppito-Delta 6, 67100 L’Aquila, Italy, 2Italian Association of Psoriatic Patients (ADIPSO), Rome, Italy, 3Department of Dermatology, University of Modena and Reggio Emilia, Italy, 4Department of Dermatology, University of L’Aquila, Italy and 5Department of Dermatology, University of Rome Tor Vergata, Italy

Email: Emma Altobelli* - emmaalto@tin.it; Mara Maccarone - segreteria@adipso.org; Reimondo Petrocelli - r.petrocelli@libero.it; Ciro Marziliano - c.marziliano@ec.univaq.it; Alberto Giannetti - giannetti.alberto@unimore.it; Ketty Peris - peris@univaq.it; Sergio Chimenti - chimenti@dermatologica.it * Corresponding author

Abstract

Background: Over recent years the public health system has shown increasing interest in patients’ views for use as guideline criteria in evaluating the quality of assistance above all for those patients with chronic diseases. Hence the interest in psoriasis, which is a chronic disease frequently associated with diabetes mellitus, hypertension, obesity, and cardiovascular diseases. The aims of our study were to describe clinic characteristics of patients with psoriasis, the quality of the assistance perceived by patients arrived at outpatients clinics and the information received, in order to identify areas in Italy requiring improvement.

Methods: 1954 patients, aged between 18 and 85 years, were consecutively enrolled at outpatients clinics across 21 Italian provinces over the period December 2004 – January 2006. A standardized questionnaire was developed in collaboration with an Italian Association of Psoriatic Patients (A.DI.PSO) and tested in a pilot study. The questionnaire was divided into three sections: the first section included social, demographic and individual variables; the second concerned the quality of the assistance perceived by the patients at public dermatologic clinics and the third focused on the need of information requirements of patients with psoriasis. The χ2 test was used to estimate the association between the categorical variables under study. Kruskal-Wallis test was applied to the interval and ordinal variables.

Results: The presence of psoriatic arthritis was reported in 26.0% of patients. Associated chronic diseases included depression (15.4%), hypertension (13.3%), obesity (8.9%) and type 2 diabetes mellitus (7.3%). The study highlighted the need of improvements of health care services at public dermatologic clinics especially in overcoming architectonic barriers and reducing appointment wait-times, particularly in South Italy. However, patients reported a positive relationship with Health System employers due to the confidentiality. This positive impression was confirmed by the observation that dermatologists were considered the best source of information about therapies on psoriasis.

Conclusion: Our study allowed to identify critical aspects which could be tackled through initiatives with the aim of improving these emerged needs.

Acknowledgements The Authors would like to thank Maurizio Maravalle (Faculty of Economics of the University of L’Aquila) for the advises on the statistical interpretation of results and the following dermatologists for their participation in the study:

Gianfranco Altomare (Milano)

Fabio Arcangeli (Cesena)

Mario Aricò (Palermo)

Giuseppe Arzenziano (Napoli)

Pier Giacomo Calzavara Pinton (Brescia)

Ugo Bottoni (Catanzaro)

Giuliano Brandozzi (Ascoli Piceno)

Francesco Cusano (Benevento)

Santo Dattola (Reggio Calabria)

Antonia Galluccio (Benevento)

Giampiero Girolomoni (Verona)

Giovanni Lo Scocco (Prato)

Torello Lotti (Firenze)

Patrizia Martini (Lucca)

Giuseppe Micali (Catania)

Iria Neri (Bologna)

Andrea Peserico (Padova)

Pietro Santoianni (Napoli)

Gino Antonio Vena (Bari)

References

1. Johnson M-LT, Roberts J: Skin conditions and related need for medical care among persons aged 1–74 years. Hyattsville, US Department of Health Education and Welfare 1978.
2. Naldi L: Inflammatory skin diseases IV: psoriasis. In The Challenge of Dermatology-Epidemiology Edited by: Williams HC, Strachan D. Boca Raton, FL: CRC Press; 1997:175-190.
3. Stern RS: The epidemiology of joint complaints in patients with psoriasis. J Rheumatol 1985, 12:315-320.
4. Scarpa R, Oriente P, Pucino A, Torella M, Pignone L, Riccio A, Biondi Oriente C: Psoriatic arthritis in psoriatic patients. Br J Rheumatol 1984, 23:246-250.
5. Salvarani C, Lo Scocco G, Macchioni P, Cremonesi T, Rossi F, Mantovani W, Battistel B, Bisighini G, Portioli I: Prevalence of Psoriatic Arthritis in Italian Psoriatic Patients. J Rheumatol 1995, 22:1499-1503.
6. Gupta MA, Gupta AK: Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol 1998, 139:846-850.
7. Krueger G, Koo J, Lebwohl M, Lebwohl M, Menter A, Stern RS, Rolstad T: The impact of psoriasis on quality life: results of a 1998 National Psoriasis Foundation patients-membership survey. Arch Dermatol 2001, 137:280-284.
8. Lindgard B: Diseases Associated with psoriasis in a General Population of 159200 Middle-Aged, Urban, Native Swedes. Dermatologica 1986, 172:298-304.
9. Henseler T, Cristophers E: Disease concomitance in psoriasis. J Am Acad Dermatol 1995, 32:982-986.
10. Cristophers E: Psoriasis – epidemiology and clinical spectrum. Clin Exp Dermatol 2001, 26:314-320.
11. NC: SAS Institute Inc: SAS/STAT User’s Guide, Version 6 fourth edition. Cary, USA; 1989.
12. Naldi L, Parazzini F, Brevi A, Peserico A, Veller Fornaia C, Grosso G, Rossi E, Marinaro E, Polenghi MM, Finzi A, Galbiati G, Recchia G, Cristofolini M, Schena D, Cainelli T: Family history, smoking habitus, alcohol consumption and risk of psoriasis. Br J Dermatol 1992, 127:212-217.
13. Chaput JC, Poynard T, Naveau S, Penso D, Durrmeyer O, Suplisson D: Psoriasis, alcohol and liver disease. Br Med J 1985, 291:25.
14. Monk BE, Neill SM: Alcohol consumption and psoriasis. Dermatologica 1986, 173:57-60.
15. Poikolainen K, Reunala T, Karvonen J, Lauharanta J, Karkkainen P: Alcohol intake: a risk factor for psoriasis in young and middle aged men? Br Med J 1990, 300:780-783.
16. Sage-Peterson K, Winchester R: Edited by: Freedberg IM, Elsen AZ, Wollff K, et al. New York: McGraw-Hill; 1999:522-533.
17. Coaccioli S, Di Cato L, Bruni PL, Papini M, Puxeddu A: A proposal of questionnaire for evaluation of the quality of life in patients with psoriatic arthritis. Recenti Prog Med 2003, 94(9):380-386.
18. Simons RD: Additional studies on psoriasis in the tropics and starvation camps. J Invest Dermatol 1949, 12:285-294.
19. Horrobin DF: Low prevalence of coronary heart disease/CHD), psoriasis, asthma and rheumatoid arthritis in eskimonos: are they caused by high dietary intake of eicosapentaenoic acid (EPA), a genetic variation of essential fatty acid (EFA) metabolismor a combination of booth? Med Hypotheses 1987, 22:421-428.
20. Renzi C, Abeni A, Picardi A, Agostini E, Melchi E, Pasquini P, Puddu P, Braga M: Factors associated with patient satisfaction with care among dermatological outpatients. Br J Dermatol 2001, 45:617-623.
21. Jefferson Medical College. In Profiles of care Philadelphia: Cancer for Research in Medical Education and Health Care; 1998.
22. Harris LE, Swindle RW, Mungai SM, Weinberger M, Tierney WM: Measuring patient satisfaction for quality improvement. Med Care 1999, 37:1207-1213.
23. Platt FW, Keller VF: Emphatic communication: a teachable and learnable skill. J Gen Intern Med 1994, 9:222-226.
24. Roter DL, Hall JA, Kern DE, Barker LR, Cole KA, Roca RP: Improving physicians’ interviewing skills and reducing emotional distress: a randomized clinical trial. Arch Intern Med 1995, 155:1877-1884.