Improving access to home phototherapy for patients with psoriasis: current challenges and future prospects

Psoriasis: Targets and Therapy Dovepress open access to scientific and medical research Review Psoriasis: Targets and Therapy downloaded from https://www.dovepress.com/ by 37.59.46.207 on 13-Jul-2018 For personal use only. Open Access Full Text Article Improving access to home phototherapy for patients with psoriasis: current challenges and future prospects This article was published in the following Dove Press journal: Psoriasis: Targets and Therapy 18 May 2016 Number of times this article has been viewed 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 Introduction Correspondence: Sylvie M Franken Department of Dermatology, VU University Medical Centre, De Boelelaan 1118, 1081HV Amsterdam, the Netherlands Fax +31 2 0444 0148 Email 55 submit your manuscript | www.dovepress.com Psoriasis: Targets and Therapy 2016:6 55–64 Dovepress © 2016 Franken et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/PTT.S81958 Powered by TCPDF (www.tcpdf.org) Phototherapy is a widely used and effective treatment for moderate-to-severe psoriasis. Many studies have proven the therapeutic effect of the different phototherapy modalities for psoriasis: psoralen with ultraviolet (UV) A, broad-band (BB)-UVB, and narrow-band (NB)-UVB. Although phototherapy was primarily used in an inpatient (Goeckerman treatment) setting, the outpatient setting later prevailed. Patients could stay at home while undergoing treatment and fulfill most of their usual day-to-day routine. Patients come two to three times a week to the hospital to undergo their treatment. A big step forward has been the inpatient setting, but it causes a different disadvantage. Patients need to travel to the hospital two to three times a week, mostly during business hours, which is costly and difficult to fit into daily life. Dovepress Psoriasis: Targets and Therapy downloaded from https://www.dovepress.com/ by 37.59.46.207 on 13-Jul-2018 For personal use only. Franken et al In 1979, Larkö and Swanbeck1 reported the first use of home phototherapy, using BB-UVB. Home treatment brought certain advantages: less travel inconvenience for patients and more control on their own schedule. Instead of the mandatory hospital visits two to three times a week, patients could undergo their treatment at home. A great step for patients with psoriasis in a society that is individualizing, and in which the schedule and autonomy of the patient has become increasingly important. Home UV treatments have further been developed; several studies were performed with low-dose UV treatment and, in particular, NB-UVB treatment.2,3 This treatment modality, however, has not become the first choice of health professionals. Outpatient UV-treatment seems to be the standard treatment modality. In this review, we try to explore the reasons for this. What is the effectivity of homebased phototherapy? What are the factors that influence the prescription of home-based phototherapy? Methods This review is based on literature searches that were performed in PubMed, Embase, and Cochrane Library databases to ascertain the effectivity of home-based phototherapy vs hospital-based phototherapy and the factors that influence its prescription. Search strategy Literature searches for relevant publications were conducted on April 22, 2015. Medline via PubMed The query used was (“Psoriasis”[Mesh] OR psoria*[tiab] OR psoria*[ot]) AND (“Phototherapy”[Mesh:NoExp] OR “Ultraviolet Therapy”[Mesh] OR phototherap*[tiab] OR actinotherap*[tiab] OR ((ultraviolet[tiab] OR uv[tiab] OR uvb[tiab] OR uva[tiab] OR photoradiat*[tiab] OR light[tiab]) AND (therap*[tiab] OR treatment*[tiab])) OR phototherap*[ot] OR actinotherap*[ot] OR ((ultraviolet[ot] OR uv[ot] OR uvb[ot] OR uva[ot] OR photoradiat*[ot] OR light[ot]) AND (therap*[ot] OR treatment*[ot]))) AND (home[tiab] OR home [ot]). Embase We used the following query: (“psoriasis”/exp OR psoria*:ab,ti) AND (“phototherapy”/de OR “phototherapy device”/de OR phototherap*:ab,ti OR actinotherap*:ab,ti OR (ultraviolet:ab,ti OR uv:ab,ti OR uvb:ab,ti OR uva:ab,ti OR photoradiat*:ab,ti OR light:ab,ti AND (therap*:ab,ti OR treatment*:ab,ti))) AND (home:ab,ti)). 56 Powered by TCPDF (www.tcpdf.org) submit your manuscript | www.dovepress.com Dovepress Cochrane Library The search included trials, Cochrane reviews, method studies, economic evaluations, and technology assessments and used the following query: (psoria*:ti,ab,kw) AND (phototherap*:ti,ab,kw or actinotherap*:ti (...truncated)