Der Hautarzt

, Volume 62, Issue 3, pp 178–188

Versorgungsforschung am Beispiel Neurodermitis

Leitthema

Zusammenfassung

Durch Studien der Versorgungsforschung wurde in den vergangenen Jahren die Relevanz und das Management der Neurodermitis in der Routineversorgung analysiert, der Nutzen der Therapie der schweren Neurodermitis quantifiziert und eine Standardisierung der Beurteilungsinstrumente für die Schwere der Neurodermitis eingeleitet. Trotz der niedrigeren Prävalenz im Erwachsenenalter sind 60% aller Patienten mit Neurodermitis Erwachsene. Es besteht eine signifikante versorgungsrelevante Komorbidität der Neurodermitis mit psychiatrischen Erkrankungen. Topische Glukokortikosteroide dominieren altersunabhängig und unabhängig von der betreuenden Fachdisziplin die ambulante Therapie der Neurodermitis. Es besteht jedoch eine ausgeprägte Heterogenität im Management der Neurodermitis durch die behandelnden Ärzte. In der Routineversorgung der schweren Neurodermitis sind systemische Glukokortikosteroide trotz fehlender klinischer Studien am weitesten verbreitet, während Ciclosporin trotz guter Studienevidenz nur selten zum Einsatz kommt. Eine aufgrund dieses Widerspruchs eingeleitete randomisierte Head-to-head-Studie zeigt eine Überlegenheit von Ciclosporin gegenüber Prednisolon in der Therapie der schweren Neurodermitis. Die medizinische Kontrolle der schweren Neurodermitis ist aus Sicht der Allgemeinbevölkerung und aus Patientenperspektive von hohem Nutzen. Ärztliche Fachkompetenz, Erkrankungsschwere und Selbstbehandlungskompetenz sind Hauptdeterminanten der Patientenzufriedenheit. Mit dem Ziel einer besseren Vergleichbarkeit von Studien und der besseren Übertragbarkeit von Studienergebnissen in die Routineversorgung wurde eine Delphi-Konsensus-Studie durchgeführt, an der klinische Experten aus 11 Ländern, Herausgeber internationaler dermatologischer Fachzeitschriften, Zulassungsbehörden und Patientenvertreter teilnahmen. Es wurde ein Konsens erzielt, demzufolge in Therapiestudien zur Neurodermitis international einheitlich Symptome, objektive klinische Zeichen und Langzeitverlauf gemessen werden und in der Routineversorgung Symptome wie Juckreiz dokumentiert werden sollen. Das Beispiel Neurodermitis zeigt exemplarisch auf, dass Versorgungsforschung nicht nur die Effektivität der medizinischen Versorgung beschreiben und kritisch bewerten, sondern im Sinne der Translationsforschung randomisierte klinische Studien implizieren und neue, klinisch relevante Hypothesen für experimentelle Studien generieren kann.

Schlüsselwörter

Neurodermitis Prävalenz Sekundärdatenanalyse Therapie Versorgungsforschung 

Health services research the example of atopic dermatitis

Abstract

Within the past years, health services research projects have analyzed critically the management of atopic eczema (AE) in routine care, quantified the utility of controlling severe AE, and introduced an international standardization of core outcome measures for AE. With a prevalence of 16%, AE is the most frequent chronic condition at all among children and adolescents seeking medical care. Despite lower prevalence in adults, about 60% of patients with AE in routine care are adults. There is a clinically relevant comorbidity of AE and psychiatric conditions. Independent of patient’s age and physician’s medical discipline topical corticosteroids dominate outpatient treatment of AE. However, there is considerable heterogeneity in the management of AE between treating physicians. Despite a lack of clinical trials, systemic corticosteroids are most frequently prescribed for severe AE. In contrast, cyclosporine only plays a minor role in routine care of severe AE although its efficacy is well-documented in trials. This observation stimulated a head-to-head trial that indicated superiority of cyclosporine over prednisolone for severe adult AE. The control of severe AE has high priority from the perspective of the general population and from the patients’ perspective. Competence of the treating physician, disease severity and patient’s competence to adjust treatment to disease activity are the main determinants of patient satisfaction. Aiming for a better comparability of clinical trials and better translation of trial evidence into clinical practice, we conducted a Delphi exercise including clinical experts from 11 countries, editors of international dermatological journals, regulatory agencies, and patient representatives. The preliminary core set of outcome domains for eczema trials as defined by the panel included symptoms, physician-assessed clinical signs, and a measurement for long-term control of flares. Symptoms such as itching should be regularly assessed in clinical practice. The presented studies indicate that health services research not only describes and critically analyzes the effectiveness of routine clinical care, but is also translational research in that it may stimulate clinical trials and generate new, clinically relevant hypotheses for experimental studies.

Keywords

Atopic dermatitis Prevalence Secondary data analysis Therapy Health services research 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Universitäts AllergieCentrum (UAC)Universitätsklinikum Carl Gustav Carus, Technische Universität DresdenDresdenDeutschland

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