Rukmini Rajagopalan - Care management of skin diseases: life quality and economic impact

Cover

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Care Management of Skin Diseases

LIFE QUALITY AND ECONOMIC IMPACT

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LIFE QUALITY AND ECONOMIC IMPACT

edited by

Rukmini Rajagopalan

Glaxo Wellcome, Inc.

Research Triangle Park, North Carolina

Elizabeth F. Sherertz

Roger T. Anderson

Bowman Gray School of Medicine of Wake Forest University

Winston-Salem, North Carolina

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ISBN: 0-8247-0128-3

The publisher offers discounts on this book when ordered in bulk quantities. For more information, write to Special Sales/Professional Marketing at the address below.

This book is printed on acid-free paper.

Copyright 1998 by Marcel Dekker, Inc. All Rights Reserved.

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Current printing (last digit):

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PRINTED IN THE UNITED STATES OF AMERICA

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This book covers the right subject matter for the health care debate of the '90s and beyond. It addresses what skin diseases do to real people in the real world, and how much impact physicians' efforts on their patients' behalf really have. Since most skin diseases are not fatal, there has been a tendency to trivialize the impact of skin disease as something merely cosmetic or of little consequence. This was not always so. In biblical times, skin disease was equated with uncleanness, and this was a cause for separation from society. In those days, chest pain did not lead to exile, but white spots on your skin would.

In today's health care debate, facts rather than opinions are expected, and these facts can result in the flow of (or paucity of) dollars for research. Malcolm Greaves encountered this problem in the United Kingdom and addressed it by studying the quality of life of patients with chronic urticaria, a disease he has researched for years. He found that the impact of chronic urticaria on the quality of life was equivalent to that of coronary artery disease. These data were of assistance in getting continued funding for further research. I was taught by the late Orville Stone at the University of Texas Medical Branch that acne could cause a young person to marry into a lower level of society due to poor self-esteem. The need for sensitivity to the quality of life of patients with skin disease is not lost on dermatologists,

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but it may be on other health professionals without quantitative data to support these opinions.

Advances in outcomes research and a need to address quality-of-care issues have fostered a debate over how much care should be delivered to various populations of patients, and who should deliver it. Dermatologists have been slow to assemble data that support the role of one treatment vis--vis another; such data will be necessary to convince third parties of the merits of our efforts on patients' behalf. This book brings together this type of information for the first time and will likely usher in a new era in which we measure the benefit of our treatments by the real impact on our patients' lives.

Robert L. Rietschel, M.D.

Chairman

Department of Dermatology

Ochsner Clinic and Alton Ochsner Medical Foundation

New Orleans, Louisiana

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This is a superb collection of chapters on quality of life and the economics of skin diseases, representing the first time that these important issues have been combined into one text. With the concerns about the rising costs of health care, we can no longer provide the best care to patients unless we understand the quality of life and economic aspects of an illness as well as the clinical aspects. The introductory section of the book includes an overview of skin diseases including epidemiology, health-related quality of life, and the patient's perspective. The quality of life section reviews the methods of developing instruments and contains specific chapters on measuring QOL in psoriasis, contact dermatitis, skin cancer, pigment disorders, viral infections, and many other disorders. The economics section includes several important chapters that cover topics such as measuring the cost- effectiveness of treatments for contact dermatitis, eczema, fungal infections, and carcinoma.

The case management section covers treatment strategies for managed care programs and primary care providers. This section also discusses the legal implications for managed care; another chapter elucidates the providers' perspective for managing dermatological patients. There are useful chapters that discuss the prevention of skin diseases and insight into future directions for these important issues. The appendix includes valuable exam

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ples of validated QOL instruments.

Health economics and quality of life are rapidly evolving research areas, and an understanding of the concepts in these chapters is critical for dealing with dermatological diseases in the dynamic health care market- place. This book will be a valuable resource for students, practitioners, and researchers. This is a significant collection of information, and anyone interested in skin disease, economics, or quality of life should find this book useful and informative.

William F. McGhan, Pharm.D, Ph.D.

Professor and Chairman

Department of Pharmacy Practice and Administration

Philadelphia College of Pharmacy and Science

Philadelphia, Pennsylvania

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The first clinical focus on quality of life developed nearly 40 years ago, with the assessment of functional status in patients being treated for cancer. Since then, the concept of health-related quality of life (HRQL) has expanded in both scope and importance in medical care. HRQL is now used to refer specifically to influences on quality of life by illnesses and their treatment rather than by nonmedical conditions. Basically, HRQL comprises an array of information about an individual's physical, social, and psychological well-being. This matrix forms a broader definition of treatment effectiveness by focusing on the ability of an individual to lead a productive and enjoyable life. HRQL also describes the burden of disease in terms of impairment of the patient's day-to-day life as well as the burden to society.