Quality statement 2: Assessing impact of disease

Quality statement

People with psoriasis are offered an assessment of the impact of the disease on physical, psychological and social wellbeing at diagnosis and when response to treatment is assessed.

Rationale

Assessing the impact of the disease on people with psoriasis at diagnosis helps identify those who may need specialist support. Psoriasis can be a stigmatising disease affecting quality of life, and its impact on wellbeing cannot be predicted from the severity of the disease. A holistic assessment needs to take place at diagnosis and when assessing response to treatment that includes reference to the impact and severity of the disease, to enable interventions to be tailored appropriately.

Quality measures

Structure

Evidence of local arrangements for people with psoriasis to have an assessment of the impact of the disease on physical, psychological and social wellbeing 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 the impact of the disease on physical, psychological and social wellbeing at diagnosis.

Numerator – the number of people in the denominator who receive an assessment of the impact of the disease on physical, psychological and social wellbeing 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 and audit support for specialist services.

b) Proportion of people with psoriasis who receive an assessment of the impact of the disease on physical, psychological and social wellbeing when response to treatment is assessed.

Numerator – the number of people in the denominator who receive an assessment of the impact of the disease on physical, psychological and social wellbeing 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 the impact of the disease on physical, psychological and social wellbeing at diagnosis and when response to treatment is assessed.

Healthcare practitioners ensure that people with psoriasis are offered an assessment of the impact of the disease on physical, psychological and social wellbeing 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 the impact of the disease on physical, psychological and social wellbeing 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 their physical, psychological and social wellbeing is affected by having psoriasis when they are diagnosed and when their 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), 1.2.1.2 and 1.2.1.7

Definitions of terms used in this quality statement

Assessment The impact of the disease on physical, psychological and social wellbeing 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.

Assessing the impact of psoriasis on physical, psychological and social wellbeing includes asking:

  • what aspects of their daily living are affected by the person's psoriasis

  • how the person is coping with their skin condition and any treatments they are using

  • if they need further advice or support

  • if their psoriasis has an impact on their mood

  • if their psoriasis causes them distress (be aware that the patient may have levels of distress and not be clinically depressed)

  • if their condition has any impact on their family or carers.

When assessing disease impact, people with psoriasis should be assessed for depression. Children and young people should be asked age-appropriate questions.

The Dermatology Life Quality Index or Children's Dermatology Life Quality Index can be used to support assessment of the impact of the disease on physical, psychological and social wellbeing.

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.