Improving access to home phototherapy for patients with psoriasis: current challenges and future prospects
Authors Franken S, Vierstra C, Rustemeyer T
Received 19 September 2015
Accepted for publication 5 February 2016
Published 18 May 2016 Volume 2016:6 Pages 55—64
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Vito Di Lernia
Peer reviewer comments 3
Editor who approved publication: Professor Uwe Wollina
Sylvie M Franken, Carlijn L Vierstra, Thomas Rustemeyer
Department of Dermatology, VU University Medical Centre, Amsterdam, the Netherlands
Introduction: Although the treatment burden for phototherapy in the outpatient setting is considerable, prescription of home-based phototherapy has not been instigated. Home-based phototherapy seems more patient friendly in terms of avoiding the thrice-weekly hospital visits. So why are most treatments still given in a hospital setting? Is home-based treatment less effective? Are there financial barriers? Is the treatment not available? To answer these questions, a literature search was done.
Methods: A literature search of PubMed, Embase, and Cochrane Library databases was performed, using the search terms “psoriasis” and “phototherapy”. Selection was based on two rounds; the first round involved screening the title and abstract of all records and second involved evaluating the full text of the remaining articles for eligibility according to inclusion and exclusion criteria.
Results: In total, 23 publications were included with consensus of both researchers. Overall, the patients reported being very satisfied with home-based phototherapy. Results regarding effectivity in terms of improvement from disease severity and in quality of life were variable but generally positive. Reasons for reluctance varied from medicolegal and social aspects to lack of reimbursement and unfamiliarity on the side of the prescriber.
Conclusion: In the treatment for psoriasis, home-based phototherapy is as effective and safe as phototherapy in an outpatient setting. Patients were more satisfied with home-based phototherapy. Factors that negatively influence the prescription of or choice for home-based phototherapy can be summarized in terms of lack of control, lack of knowledge, and lack of a good reimbursement system.
Keywords: psoriasis, phototherapy, UVB, home-based, effectiveness, burden, costs, access
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