ISSN:
1365-2133
Source:
Blackwell Publishing Journal Backfiles 1879-2005
Topics:
Medicine
Notes:
Following publication of treatment guidelines for patients with psoriasis, a six-centre audit was undertaken to assess current therapeutic practice for two second-line treatments, PUVA and methotrexate. The audit consisted of random sampling of casenotes by external auditors from a paired dermatology department, and assessment by questionnaire. One hundred and eight PUVA and 118 methotrexate casenotes were audited. The commonest indications for treatment were: (a) failure of topical therapy-PUVA (mean 81% of casenotes), methotrexate (84%); (b) repeated hospital admissions-PUVA (16%), methotrexate (25%).For both PUVA and methotrexate, some aspects of treatment were well documented: PUVA-psoralen dosage (91%), response to PUVA (89%), cumulative lifetime UVA dosage (81%); methotrexate-pretreatment assessment of full blood count (91%), urea and electrolytes (85%), liver function tests (84%). For other aspects documentation was less complete: PUVA-no documentation of presence/absence of skin cancer history (66%), note of photoactive drugs (32%); methotrexate—concurrent medication (69%), history of presence/absence of liver disease (36%). Another aspect which was poorly documented in both PUVA and methotrexate notes was whether advice on contraception/fertility had been given. There was no indication in 29 of 32 casenotes of females of child-bearing age receiving PUVA, and 52 of 63 case notes of relevant patients on methotrexate.This project has demonstrated that formal, multicentre audit based on published guidelines is a practical proposition.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1111/j.1365-2133.1994.tb08495.x
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