Eczema In Primary Care Research Articles

Atopic eczema in primary care: evidence update and implications for practice.

Atopic eczema in primary care: evidence update and implications for practice.

Enabling self-management of eczema in primary care

Practice nurses are ideally placed to manage chronic eczema, writes Julie Van Onselen

Enabling self-management of eczema in primary care

Eczema is a very common and, generally, long-term condition found across all age groups. Practice nurses are skilled in chronic disease management and are ideally placed to manage eczema in general practice, and the step-wise principles of asthma care can also be applied to eczema care. These principles are aimed at enabling patient self-management by supporting and educating them in ‘preventers’, daily complete emollient therapy and ‘relievers’, treating symptoms quickly, generally with a short course of topical steroids. Patients with eczema can be educated in identifying individual triggers (such as irritants and allergens), recognising flares and complications, such as infection, and knowing when to seek health professional support.

Exploring the Effect of Nice Guidelines on Prescribing for Childhood Atopic Eczema in Primary Care with An Interrupted Time Series

IntroductionAtopic eczema (AE) is a chronic inflammatory skin condition affecting 20-32% of UK children, typically diagnosed and treated in primary care. National Institute of Health and Clinical Excellence (NICE, 2007) guidelines recommend all children presenting with AE in primary care are prescribed emollient; topical corticosteroids (TCS) are co-prescribed if indicated by severity. The proportion of children receiving recommended treatment and NICE guideline impact on prescribing practices is unknown. This study was the first to access population-level UK-wide primary care dermatology data from SystmOne.
 Objectives and ApproachWe explored treatment patterns for childhood AE documented in primary care data from SystmOne.
 Secondary analysis of retrospective, longitudinal primary care data for childhood (<12yo) AE-related consultations from 2002 to 2013. Four treatment scenarios were compared: 1) emollient and TCS co-prescribed (NICE-recommended for moderate-high severity presentation), 2) emollient only (NICE-recommended for mild severity presentation), 3) TCS only (not recommended), or 4) no topical treatment prescribed (not recommended). ARIMA used to examine step and trend-change in prescribing following guideline release.
 ResultsNICE-recommended treatments were more common following guideline release: emollient+TCS increased 8% (95%CI 7.7,8.7%); emollient alone increased 8% (95%CI 7.8,8.8%); TCS alone decreased 5% (95%CI -4.2,-5.1%); and no treatment decreased 11% (95%CI -11.3,-12.3%).
 Longitudinal analysis indicated increased NICE-recommended prescribing was due to pre-existing trends not significantly altered by the guideline release. By December 2013, ~334 children per month were still not receiving recommended AE treatment (37% of ~900 first-time consultations/month).
 Conclusion / ImplicationsAdherence to best practice guidelines for treatment and management of childhood atopic eczema is currently sub-optimal. Significant barriers to optimal use of this data could be achieved by improving design of data input interfaces with secondary use for research in mind. As well as study findings, this presentation will share challenges associated with utilising routinely collected SystmOne data for research purposes for the first time in the UK.

Enabling self-management of eczema in primary care

Eczema is a very common and, generally, long-term condition found across all age groups. Practice nurses are skilled in chronic disease management and are ideally placed to manage eczema in general practice, and the step-wise principles of asthma care can also be applied to eczema care. These principles are aimed at enabling patient self-management by supporting and educating them in ‘preventers’, daily complete emollient therapy and ‘relievers’, treating symptoms quickly, generally with a short course of topical steroids. Patients with eczema can be educated in identifying individual triggers (such as irritants and allergens), recognising flares and complications, such as infection, and knowing when to seek health professional support.

GP and parent dissonance about the assessment and treatment of childhood eczema in primary care: a qualitative study

ObjectivesTo compare parents’ and clinicians’ perspectives on the assessment and treatment of children with eczema in primary care.DesignQualitative interview study with purposive and snowball sampling and thematic analysis.Setting14 general practices...

Impact of a deferred recruitment model in a randomised controlled trial in primary care (CREAM study)

BackgroundRecruitment of participants is particularly challenging in primary care, with less than a third of randomised controlled trials (RCT) achieving their target within the original time frame. Participant identification, consent, randomisation and data collection can all be time-consuming. Trials recruiting an incident, as opposed to a prevalent, population may be particularly affected. This paper describes the impact of a deferred recruitment model in a RCT of antibiotics for children with infected eczema in primary care, which required the recruitment of cases presenting acutely.MethodsEligible children were identified by participating general practitioners (GPs) and referred to a study research nurse, who then visited them at home. This allowed the consent and recruitment processes to take place outside the general practice setting.Information was recorded about patients who were referred and recruited, or if not, the reasons for non-recruitment. Data on recruitment challenges were collected through semi-structured interviews and questionnaires with a sample of participating GPs. Data were thematically analysed to identify key themes.ResultsOf the children referred to the study 34% (58/171) were not recruited – 48% (28/58) because of difficulties arranging a baseline visit within the defined time frame, 31% (18/58) did not meet the study inclusion criteria at the time of nurse assessment, and 21% (12/58) declined participation. GPs had positive views about the recruitment process, reporting that parents valued and benefitted from additional contact with a nurse. GPs felt that the deferred recruitment model did not negatively impact on the study.ConclusionsGPs and parents recognised the benefits of deferred recruitment, but these did not translate into enhanced recruitment of participants. The model resulted in the loss of a third of children who were identified by the GP as eligible, but not subsequently recruited to the study. If the potential for improving outcomes in primary care through complex studies is to be realised, new approaches to recruitment into primary care trials need to be developed and evaluated.Trial registrationInternational Standard Randomised Controlled Trials, ISRCTN96705420. Registered on 27 June 2012.

Diagnosis, assessment, and treatment of childhood eczema in primary care: cross-sectional study.

BackgroundThe majority of children with eczema in the UK are looked after in primary care yet we know little about their care in this setting.AimTo compare the diagnosis, assessment, and treatment of eczema in primary care with published diagnostic criteria and management guidelines.Design & settingCross-sectional study using data from a randomised controlled feasibility study. General practices, UK.MethodBaseline data from children aged 1 month to 5 years recruited ‘in-consultation’ for the Choice of Moisturiser in Eczema Treatment (COMET) feasibility study was used. These included clinician diagnosis and global severity assessment; the parent-completed Patient Orientated Eczema Measure (POEM); a questionnaire about eczema treatments, including use of topical corticosteroid (TCS); and, the Eczema Area Severity Index (EASI) carried out by trained researchers. Descriptive analyses were undertaken to compare diagnoses with UK diagnostic criteria, severity assessments, and treatment with the National Institute for Health and Care Excellent (NICE) guidance.ResultsData were available for 90 participants. Only 46% of participants labelled as having eczema met the UK diagnostic criteria. Agreement between the global severity assessment by a healthcare practitioner with the EASI and POEM measures of eczema severity were 44% and 48% respectively. Emollients and TCSs were underused with 44% of participants not using any emollient and 46% using one or more TCSs. The ‘match’ between eczema severity and TCSs potency was poor.ConclusionDiscrepancies were found between the diagnosis, assessment, and treatment of children with eczema in primary care, and UK diagnostic criteria and guidelines. Further investigation to explore the reasons for this discordance, and whether it matters, is needed.

Prescribing for children with atopic eczema in primary care

Atopic eczema affects around 1 in 5 children at some point in childhood, so it is important that primary-care clinicians can assess and manage this condition. Rebecca Penzer describes the available topical products and explains how you can develop a patient-centred plan Atopic eczema is a common childhood condition. this article gives guidance on patient assessment; developing a patient-centred plan of care; the topical products most effective for managing the condition; how optimal adherence to the treatment may be achieved; and when referral to services in secondary care is appropriate.

Use of emollients in the management of atopic eczema

British Journal of Community NursingVol. 21, No. 2 CommentUse of emollients in the management of atopic eczemaShelley PeacockShelley PeacockSearch for more papers by this authorShelley PeacockPublished Online:4 Feb 2016https://doi.org/10.12968/bjcn.2016.21.2.76AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Akdis CA, Akdis M, Bieber T et al. (2006) Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. Allergy 61(8): 969–87 Crossref, Medline, Google ScholarErsser S, Maguire S, Nicol N, Penzer R, Peters J (2007) Best Practice in Emollient Therapy: A Statement for Healthcare Professionals. Dermatology UK Ltd, Aberdeen Google ScholarNational Eczema Society (2015a) What is eczema? www.eczema.org/what-is-eczema (accessed 26 January 2016) Google ScholarNational Eczema Society (2015b) Treatments. www.eczema.org/basic-treatment (accessed 26 January 2016) Google ScholarNational Institute for Health and Care Excellence (2007) NICE guidelines [CG57]. Atopic eczema in under 12s: diagnosis and management. www.nice.org.uk/guidance/cg57 (accessed 18 January 2016) Google ScholarNational Institute for Health and Care Excellence (2011) NICE guidelines [CG116]. Food allergy in under 19s: assessment and diagnosis. www.nice.org.uk/guidance/cg116 (accessed 18 January 2016) Google ScholarPeate I (2011) Eczema: causes, symptoms and treatment in the community. Br J Community Nurs 16(7): 324–31 Link, Google ScholarPenzer R, Ersser J (2010) Principles of Skin Care: A Guide for Nurses and Other Health Professionals. Wiley-Blackwell, Chichester Crossref, Google ScholarPenzer R (2012) Best practice in emollient therapy. A statement for healthcare professionals. 3rd edn. Dermatological Nursing 11(4): S1–19 Google ScholarScottish Intercollegiate Guidelines Network (2011) National clinical guideline 125. Management of atopic eczema in primary care. http://sign.ac.uk/pdf/sign125.pdf (accessed 26 January 2016) Google ScholarSehra S, Tuana FM, Holbreich M et al. (2008) Scratching the surface: towards understanding the pathogenesis of atopic dermatitis. Crit Rev Immunol 28(1): 5–43 Crossref, Google ScholarShamssain M (2007) rends in the prevalence and severity of asthma, rhinitis and atopic eczema in 6- to 7- and 13- to 14-yr-old children from the north-east of England. Pediatr Allergy Immunol 18(2): 149–53 Crossref, Medline, Google ScholarVoegeli D, Smith & Nephew Foundation (2007) Factors that exacerbate skin breakdown and ulceration. In: Skin Breakdown: The Silent Epidemic. Smith & Nephew Foundation, London, UK: 17–21 Google Scholar FiguresReferencesRelatedDetailsCited byHygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings23 January 2020 | Cochrane Database of Systematic Reviews, Vol. 2020, No. 1Atopic Eczema: Genetic Associations and Potential Links to Developmental Exposures30 March 2017 | International Journal of Toxicology, Vol. 36, No. 3Reviewing emollients13 October 2016 | Nurse Prescribing, Vol. 14, No. 10 2 February 2016Volume 21Issue 2ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 4 February 2016 Published in print 2 February 2016 Information© MA Healthcare LimitedPDF download

The impact of a delayed consent model on trial recruitment - the cream study (children with eczema antibiotic management study)

Background The CREAM Study is a randomised controlled trial that aims to address the uncertainty around the effect of oral and topical antibiotics on subjective and objective eczema severity in children with clinically infected eczema in primary care. Children were identified by GPs and referred to local CREAM research nurses. Research nurses arranged a baseline visit to the participant’s home with 72 hours. Eligibility was re-confirmed at the visit and informed consent was obtained.

Prescribing for children with atopic eczema in primary care

Atopic eczema is a common childhood condition. This article gives guidance on patient assessment; developing a patient-centred plan of care; the topical products most effective for managing the condition; how optimal adherence to the treatment may be achieved; and when referral to services in secondary care is appropriate.

Current management of atopic eczema in primary care

AbstractAtopic eczema is a chronic and distressing skin condition that affects the lives of many patients and their families in the UK. This Drug review discusses the recommended management of atopic eczema, followed by a list of useful resources, an analysis of prescription data and the Datafile. Copyright © 2008 Wiley Interface Ltd

Corrigendum to ‘Gender-specific presentations for asthma, allergic rhinitis and eczema in primary care’ [Prim Care Resp J 2007;16(1):28–35

The authors regret that an error occurred on page 30, caption to Figure 2: The caption 'Patient consultation rates for asthma by single year of age for ages...' should read: 'Patient consultation rates for allergic rhinitis by single year of age for ages...'

Gender-specific presentations for asthma, allergic rhinitis and eczema in primary care

To identify age- and gender-specific prevalence rates for physician-diagnosed asthma, allergic rhinitis (AR) and eczema across a whole lifespan. Presentations of asthma, allergic rhinitis and eczema were identified in individuals aged 0 to 65 who consulted their general practitioner at least once in 1998-99 from a population sample of 266,733 in Scotland, and in 1991-95 for asthma and allergic rhinitis in 6,836,063 person years at risk in England and Wales. In both sexes asthma presentations peak at 4-6 years whilst eczema peaks in infancy. A second asthma peak occurs during adolescence, earlier in females, at a time when a female predominance for all three atopic diseases is established. Female predominance of eczema presentations are limited to the reproductive period of 15-49 years. The patterns of presentations for asthma, allergic rhinitis and eczema by age and gender suggest important gender-specific differences in disease predisposition and diagnosis.