To evaluate if an educational handbook could improve atopic dermatitis (AD) symptoms, caregiver confidence in AD management skills, and AD-related quality of life.In the study, researchers included children ages 1 month to 16 years with AD and their caregivers who had scheduled new or follow-up clinic appointments for the evaluation and management of AD at Boston Children’s Hospital. Inclusion criteria consisted of AD diagnosis confirmed by the health care provider during a clinic visit and an English-speaking caregiver.A randomized nonblinded controlled trial that was stratified to handbook and control arm. In the handbook arm, participants received a handbook in addition to standard AD care, versus only standard care in the control arm. Furthermore, each clinical program from which the participants was recruited was a separate randomization block. These clinical programs included allergy, dermatology, the Atopic Dermatitis Center (an interdisciplinary specialty clinic for AD), and primary care. All caregivers completed a self-reported questionnaire at baseline and a 3-month follow-up. After the baseline visit, the participants in the handbook arm were given a handbook and told to read it as a tool to help manage the child’s AD. The symptoms associated with AD were measured by using the Patient-Oriented Eczema Measure (POEM). POEM scores range from 0 (clear; no eczema) to 28 (severe eczema).A total of 245 patients from the ages of 3 months to 16 years were randomly assigned in this study. Of the total 245 randomly assigned patients, 175 caregivers completed questionnaires and were included in the repeated-measure analysis. There were 91 caregivers in the handbook arm and 84 in the control arm. The patients lost to follow-up were more likely to be African American or Hispanic (P < .14). The adjusted mean POEM score (±SD) decreased from 12.1 ± 9.9 to 7.7 ± 8.7 (difference: −4.4 [95% confidence interval (CI): −5.7 to −3.0]) in the handbook arm and 12 ± 10 to 8.6 ± 8.8 in the control arm (difference: −3.4 [95% CI: −4.8 to −2.0]; P = .343). Confidence scores (P = .093), infant quality of life (P = .944), child quality of life scores (P = .114), and family impact scores (P = .933) were not significant between time and study arm. The adjusted mean confidence score among new patients increased from 67 (95% CI: 60 to 74) to 83 (95% CI: 77 to 88) in the handbook arm, compared with 74 (95% CI: 65 to 82) to 75 (95% CI: 67 to 83) in the control arm (P = .012). Most of the caregivers found the handbook to be helpful.The use of the handbook did not significantly improve AD symptoms, when compared with standard care alone. Nonetheless, caregivers did find the handbook useful, and it may be especially useful to families managing a new diagnosis of AD.As health care providers, we often look for new and innovative ways to improve the care for our patients. Although, in this study, researchers did not find a significant difference in symptom or quality of life outcomes versus standard management, it is not to say another or modified tool would not have the desired impact. Consequently, the analysis of educational resources among various study populations and diseases should continue in an effort to improve overall management and health outcomes.
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