gms | German Medical Science

Background and status of (inter)national research: Diagnosis and treatments of patients with psoriasis vulgaris, urtikaria or lupus erythematosus are often treated by different medical disciplines. The chronic character of these diseases with recurrent symptoms and protracted treatments can lead to emotional and mental stress as well as physical isolation. In a rural population, misdiagnosis and consequently withheld therapy options in the sense of underuse can occur.

Question and objective: The current care situation and quality of care of patients with the above-mentioned diagnoses was prospectively investigated at the University Hospital Regensburg.

Method or hypothesis: A cross-sectional study was conducted at the Department of Dermatology at the University Hospital Regensburg. The patient data using EQ-5D-5L and DLQI served as the basis for the health-related quality of life. In the context of this study, rural region and care were operationalised via the access route to the University Hospital as maximum care provider in the region and 50km was set as the threshold.

Results: 212 patients (psoriasis vulgaris: 124, urtikaria: 57, lupus: 31) could be included in the recording period. Regarding the travel distance of the patients from the rural region, it was shown that 48% of the patients had a travel distance longer than 50km to the University hospital, while 53% of the patients had a travel distance <50km. Patients with a longer journey generally had a worse quality of life (DLQI score). The DLQI score was 8.3 in patients with lupus, 9.2 in patients with psoriasis and 10.8 in patients with urtikaria (general population DLQI: 0 – 0.5). The EQ-5D-5L showed a VAS score of 61.6 in patients with a travel distance of >50km and 66.3 in patients with a travel distance of less than 50km (non-standardised VAS score in Germany 77.3). Based on their current health status, the majority of patients are willing to travel >50km to reach appropriate treatment. A maximum waiting time between 30 min and 1 h is tolerated.

Discussion: The evaluation further showed that the patients considered it very important that their care situation must be improved at present and that a successful outpatient therapy on site (rural region) is very important for them. The need to avoid an inpatient stay is also very important for these patients. It did not matter whether the journey was short or long. The patients' value for the importance of dermatological specialist treatment is higher compared to other specialist treatment. In all three groups, the patients considered it very important to improve the current medical care situation. Therefore, it is necessary to identify problems in the dermatological care of patients with the above-mentioned diagnoses in rural regions and to work out possible solutions for improving the care of these patients.

Practical implications: The most important factors from patient’s standpoint were the allocation of appointments within 4 weeks, short waiting time for the appointment itself , specialist treatment (here: dermatologist) and to avoid an inpatient stay.

Appeal for practice (science and/or care) in one sentence: The improvement of the medical care situation in rural areas for patients with psoriasis vulgaris, lupus erythematosus and urtikaria.