Prescribing and using vitiligo treatments: lessons from a nested process evaluation within the HI-Light vitiligo randomized controlled trial
Prescribing and using vitiligo treatments: lessons from a nested process evaluation within the HI-Light vitiligo randomized controlled trial
Background: The HI-Light Trial demonstrated that for active, limited vitiligo, combination treatment with potent topical corticosteroid (TCS) and handheld narrowband ultraviolet B offers a better treatment response than potent TCS alone. However, it is unclear how to implement these findings. Aim: We sought to answer three questions: (i) Can combination treatment be used safely and effectively by people with vitiligo?; (ii) Should combination treatment be made available as routine clinical care?; and (iii) Can combination treatment be integrated within current healthcare provision?. Methods: This was a mixed-methods process evaluation, including semi-structured interviews with a purposive sample of trial participants, structured interviews with commissioners, and an online survey and focus groups with trial staff. Transcripts were coded by framework analysis, with thematic development by multiple researchers. Results: Participants found individual treatments easy to use, but the combination treatment was complicated and required nurse support. Both participants and site investigators felt that combination treatment should be made available, although commissioners were less certain. There was support for the development of services offering combination treatment, although this might not be prioritized above treatment for other conditions. A ‘mixed economy’ model was suggested, involving patients purchasing their own devices, although concerns regarding the safe use of treatments mean that training, monitoring and ongoing support are essential. The need for medical physics support may mean that a regional service is more practical. Conclusion: Combination treatment should be made available for people seeking treatment for vitiligo, but services require partnership with medical physics and ongoing training and support for patients.
Dermatologic Agents/therapeutic use, Humans, Surveys and Questionnaires, Treatment Outcome, Ultraviolet Therapy/methods, Vitiligo/drug therapy
1480-1489
Leighton, Paul
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Chalmers, Joanne R.
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Batchelor, Jonathan M.
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Rogers, Andy
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Akram, Perways
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Haines, Rachel H.
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Meakin, Garry D.
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White, Jennifer
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Ravenscroft, Jane C.
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Sach, Tracey H.
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Santer, Miriam
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Whitton, Maxine E.
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Eleftheriadou, Viktoria
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Thomas, Kim S.
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1 August 2022
Leighton, Paul
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Chalmers, Joanne R.
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Batchelor, Jonathan M.
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Rogers, Andy
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Akram, Perways
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Haines, Rachel H.
efd463e9-1a86-4370-8a76-21e3065f8350
Meakin, Garry D.
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White, Jennifer
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Ravenscroft, Jane C.
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Sach, Tracey H.
5c09256f-ebed-4d14-853a-181f6c92d6f2
Santer, Miriam
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Whitton, Maxine E.
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Eleftheriadou, Viktoria
3921e554-2fda-4415-b493-d7e64ba6d64c
Thomas, Kim S.
75e143ff-868e-47dc-b892-c9745a7e496a
Leighton, Paul, Chalmers, Joanne R., Batchelor, Jonathan M., Rogers, Andy, Akram, Perways, Haines, Rachel H., Meakin, Garry D., White, Jennifer, Ravenscroft, Jane C., Sach, Tracey H., Santer, Miriam, Whitton, Maxine E., Eleftheriadou, Viktoria and Thomas, Kim S.
(2022)
Prescribing and using vitiligo treatments: lessons from a nested process evaluation within the HI-Light vitiligo randomized controlled trial.
Clinical and Experimental Dermatology, 47 (8), .
(doi:10.1111/ced.15193).
Abstract
Background: The HI-Light Trial demonstrated that for active, limited vitiligo, combination treatment with potent topical corticosteroid (TCS) and handheld narrowband ultraviolet B offers a better treatment response than potent TCS alone. However, it is unclear how to implement these findings. Aim: We sought to answer three questions: (i) Can combination treatment be used safely and effectively by people with vitiligo?; (ii) Should combination treatment be made available as routine clinical care?; and (iii) Can combination treatment be integrated within current healthcare provision?. Methods: This was a mixed-methods process evaluation, including semi-structured interviews with a purposive sample of trial participants, structured interviews with commissioners, and an online survey and focus groups with trial staff. Transcripts were coded by framework analysis, with thematic development by multiple researchers. Results: Participants found individual treatments easy to use, but the combination treatment was complicated and required nurse support. Both participants and site investigators felt that combination treatment should be made available, although commissioners were less certain. There was support for the development of services offering combination treatment, although this might not be prioritized above treatment for other conditions. A ‘mixed economy’ model was suggested, involving patients purchasing their own devices, although concerns regarding the safe use of treatments mean that training, monitoring and ongoing support are essential. The need for medical physics support may mean that a regional service is more practical. Conclusion: Combination treatment should be made available for people seeking treatment for vitiligo, but services require partnership with medical physics and ongoing training and support for patients.
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Accepted/In Press date: 23 March 2022
e-pub ahead of print date: 26 March 2022
Published date: 1 August 2022
Additional Information:
© 2022 The Authors. Clinical and Experimental Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.
Keywords:
Dermatologic Agents/therapeutic use, Humans, Surveys and Questionnaires, Treatment Outcome, Ultraviolet Therapy/methods, Vitiligo/drug therapy
Identifiers
Local EPrints ID: 457669
URI: http://eprints.soton.ac.uk/id/eprint/457669
ISSN: 0307-6938
PURE UUID: d668b229-5dd3-4612-b56a-e139f73e0378
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Date deposited: 14 Jun 2022 17:00
Last modified: 17 Mar 2024 04:19
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Contributors
Author:
Paul Leighton
Author:
Joanne R. Chalmers
Author:
Jonathan M. Batchelor
Author:
Andy Rogers
Author:
Perways Akram
Author:
Rachel H. Haines
Author:
Garry D. Meakin
Author:
Jennifer White
Author:
Jane C. Ravenscroft
Author:
Tracey H. Sach
Author:
Maxine E. Whitton
Author:
Viktoria Eleftheriadou
Author:
Kim S. Thomas
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