Prescribing and using vitiligo treatments : lessons from a nested process evaluation within the HI-Light vitiligo randomized controlled trial
Author
Leighton, PaulChalmers, 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
Thomas, Kim S
Affiliation
University of Nottingham; Nottingham University Hospitals NHS Trust; Nottingham Children's Hospital; University of East Anglia; University of Southampton; Walsall Healthcare NHS TrustPublication date
2022-05-30Subject
Dermatology
Metadata
Show full item recordAbstract
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.Citation
Leighton P, Chalmers JR, Batchelor JM, Rogers A, Akram P, Haines RH, Meakin GD, White J, Ravenscroft JC, Sach TH, Santer M, Whitton ME, Eleftheriadou V, Thomas KS. Prescribing and using vitiligo treatments: lessons from a nested process evaluation within the HI-Light vitiligo randomized controlled trial. Clin Exp Dermatol. 2022 Aug;47(8):1480-1489.Type
ArticlePMID
35340044Publisher
Oxford University Pressae974a485f413a2113503eed53cd6c53
10.1111/ced.15193