Quality statement 1: Assessing disease severity

Quality statement

People with psoriasis are offered an assessment of disease severity at diagnosis and when response to treatment is assessed.

Rationale

Assessing disease severity in people with psoriasis at diagnosis is important because it is the first step in treatment planning. It provides a benchmark for treatment efficacy to be measured against at all subsequent assessments, which are essential to monitor response to treatment. A holistic assessment needs to take place at diagnosis and when assessing response to treatment that includes reference to the severity and impact of the disease, to enable treatment to be optimised.

Quality measures

Structure

Evidence of local arrangements for people with psoriasis to receive an assessment of disease severity at diagnosis and when response to treatment is assessed.

Data source: Local data collection.

Process

a) Proportion of people with psoriasis who receive an assessment of disease severity at diagnosis.

Numerator – the number of people in the denominator who receive an assessment of disease severity at diagnosis.

Denominator – the number of people with psoriasis.

Data source: Local data collection. Contained in NICE clinical guideline 153 audit support for non-specialist services.

b) Proportion of people with psoriasis who receive an assessment of disease severity when response to treatment is assessed.

Numerator – the number of people in the denominator who receive an assessment of disease severity when response to treatment is assessed.

Denominator – the number of people with psoriasis receiving treatment.

Data source: Local data collection.

What the quality statement means for service providers, healthcare practitioners, and commissioners

Service providers ensure that systems are in place for people with psoriasis to be offered an assessment of disease severity at diagnosis and when response to treatment is assessed.

Healthcare practitioners ensure that people with psoriasis are offered an assessment of disease severity at diagnosis and when response to treatment is assessed.

Commissioners ensure that they commission services for people with psoriasis to be offered an assessment of disease severity at diagnosis and when response to treatment is assessed.

What the quality statement means for patients, service users and carers

People with psoriasis are offered an assessment of how severe their psoriasis is when they are diagnosed and when the response to the treatment is assessed.

Source guidance

Psoriasis: assessment and management (2012, updated 2017) NICE guideline CG153, recommendations 1.2.1.1 (key priority for implementation) and 1.2.1.2

Definitions of terms used in this quality statement

Assessment The severity of the disease should be assessed at first presentation and to evaluate the efficacy of interventions. It should also be assessed before referral for specialist advice and at each referral point in the treatment pathway.

The assessment includes recording the body surface area affected, any involvement of nails, high-impact and difficult-to-treat sites (for example, the face, scalp, palms, soles, flexures and genitals) and any systemic upset such as fever and malaise, which are common in unstable forms of psoriasis, such as erythroderma or generalised pustular psoriasis.

The Physician's Global Assessment and Patient's Global Assessment tools can be used to support assessment of disease severity. In specialist settings, the Psoriasis Area and Severity Index and Nail Psoriasis Severity Index can also be used.

Response to treatment Response to treatment should be evaluated by an assessment of disease severity at a time appropriate to the treatment. NICE guidance recommends the following timeframes:

  • Within 4 weeks of starting a new topical treatment in adults (within 2 weeks for a very potent corticosteroid in scalp psoriasis and corticosteroids for people with psoriasis of the face, flexures or genitals).

  • Within 2 weeks of starting a new topical treatment in children.

  • Within 3 months of starting phototherapy or systemic non-biological therapy.