The treatment of patients with psoriasis or eczema can be optimized by using the right (medicine) resources in good time. Research by the Nivel and the Zorginstituut shows that only 50-63% of patients are prescribed a cream or ointment without a medicine (indifferent medicine), while this is the recommended basic treatment. A dermatocorticosteroid was also prescribed less often than should be for eczema or psoriasis. The research was conducted within the Research Workplace ‘Routine care data for appropriate care’.
Patients with atopic eczema or psoriasis are not always adequately treated in primary care. This came to the fore during the screening phase of the Zinnige Zorg trajectories about skin diseases of the National Health Care Institute. The follow-up research now shows that (medicinal) medicines are not used or are used only too late, or that the resources are not strong enough. As a result, patients often have to apply for longer, which can lead to patients becoming “tired” and a decrease in adherence. If the resources are used correctly, according to the NHG standards ‘eczema’ and ‘psoriasis’, they form the basis for an appropriate stepped care treatment of the skin conditions.
Insufficient use of both medicinal and non-medicinal substances
A third to half of patients with psoriasis or atopic eczema are not prescribed an indifferent remedy (a dermatological product, such as an ointment, without a medicine), although this is the recommended treatment according to the guideline. In addition, patients with more severe forms of eczema and psoriasis often require drug treatment in the form of dermacorticosteroids. The guidelines advise only referring to a specialist if the treatment with this medication does not have sufficient effect. However, the analyzes showed that 18-31% of patients were referred without the use of dermacorticosteroids. In addition, it appears that the correct classes of dermacorticosteroids are not always used and that the stepped care approach is followed.
Healthcare institute presents improvement goals for healthcare parties
This research is part of the in-depth phase of the Zinnige Zorg for people with eczema and psoriasis project. Partly on the basis of these results, the ‘Improvement Report’ of the Zorginstituut includes ‘improvement agreements’ in order to be able to treat patients in primary care more effectively and not to refer unnecessarily to secondary care. The next step in the Sense Care process is the implementation phase. This is where the proposed improvement in healthcare is realised. The responsibility for this rests with the care parties themselves.
About the research
We used non-traceable data from patients diagnosed with contact dermatitis, atopic dermatitis or psoriasis between 2015-2019. We linked data from electronic patient files, from general practices that are part of Nivel Zorgregistratie Eerste Lijn, to claim data from health insurers. The research is part of the Research Workplace ‘Routine care data for appropriate care’ of Nivel and the Zorginstituut.