The development of the clinical pathway for a moderate to severe psoriasis in Malaysia

Introduction: Clinical Pathway (CP) is a care plan provided for patients with medical problems using organized procedures. The establishment of standardization, the reduction in terms of the differences between each treatment process, cost containment, and the improvement of treatment quality are essential. Therefore, CP has been utilized in healthcare settings for these purposes. However, as the criteria for the formulation of CP is unspecified, there has been lack of agreement regarding the effectiveness of CP among researchers and clinicians. Based on general knowledge, there was no evidence about the use of CP for a moderate to severe Psoriasis. Objective: This paper describes the collaborative efforts between UKMMC and MOH hospitals in developing a CP for moderate to severe psoriasis in Malaysia. Methodology: The development of the CP consisted of three steps, where: 1) composition of team, 2) standardization of case definition, 3) development of the draft for CP, 4) modification of CP requirement for agreement, and 5) finalization of CP. Following that, an agreement was achieved amongst all dermatologists regarding the specifications for moderate to severe psoriasis, which were BSA < 10, PASI < 10, DLQI < 10. Result: the sections of final CP consisted of; a) general examination where weight, height, BSA, PASI, DLQI, laboratory investigation, and procedural examination were involved, b) the sections for modality's requirements, where the list of drugs specialized for four modalities were involved; they were topical, phototherapy systemic and biologic, and c) additional plans for treatment, where referral to other specialists, counseling, and follow up were involved. Conclusion: This CP was developed in compliance with Evidence Based Medicine. However, future research is required in order to address the use of CP under certain conditions with standardized criteria, for the acquirement of homogenous and comparable results.