Improved emollient use reduces atopic eczema symptoms and is cost neutral in infants: before-and-after evaluation of a multifaceted educational support programme

BMC Family Practice

Michael J Cork⁵  Josh Taylor⁴  Phillip Berry³  Steve Hewitt³  Carolyn Buckley³  Julie Carr¹  James M Mason² 

[1] Sheffield Children’s NHS Foundation Trust, Sheffield, UK;School of Medicine, Pharmacy & Health, Durham University, Durham, UK;Reckitt Benckiser Healthcare UK, Slough, UK;Partizan International, London, UK;Department of Infection and Immunity, The University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX, UK

关键词: Educational support;    Patient support;    Health economics;    Community study;    Measurement;    Symptoms;    Compliance;    Emollient therapy;    Children;    Atopic eczema;   

Others  :  855058
DOI  :  10.1186/1471-5945-13-7

 received in 2013-01-18, accepted in 2013-04-29,  发布年份 2013

【 摘 要 】

Background

Parents and carers of children with eczema often underuse emollient therapy, essential to repairing and protecting the defective skin barrier in atopic eczema. Educational interventions delivered by specialist dermatology nurses in hospital settings have been shown to improve emollient use and reduce symptoms of atopic eczema, but benefits of community-based interventions are uncertain. Support and information about appropriate care may often be inadequate for patients and carers in the community.

Methods

A multifaceted educational support programme was evaluated as a method of increasing emollient use and reducing atopic eczema in children. Support provided for parents and carers included an educational DVD, online daily diary and telephone helpline. The before and after study included 136 British children and their parents, providing baseline and 12 week follow-up data while receiving the programme. Measures included emollient use, POEM and PEST scores, and cost of care.

Results

Average emollient use increased by 87.6 g (95% CI: 81.9 to 119.5 g, p = 0.001) from baseline with the change being immediate and persistent. The POEM score reduced on average by 5.38 (95% CI: 4.36 to 6.41, p = 0.001), a 47% reduction from baseline. Similarly the PEST score reduced on average by 0.61 (95% CI: 0.47 to 0.75, p = 0.001), a 48% reduction from baseline. Sleep disturbance was reduced by 1.27 nights per week (95% CI: 0.85 to 1.68, p = 0.001) and parental feeling of control improved by 1.32 points (95% CI: 1.16 to 1.48, p = 0.001). From the NHS perspective, the programme was cost neutral overall within the study period.

Conclusion

A community-based multifaceted educational support programme greatly increased emollient use, reducing symptoms of atopic eczema and general practitioner contacts, without increasing cost. Significant benefits may accrue to the families and carers of children with atopic eczema due to improved sleep patterns and greater feeling of control. PEST, a new simple measure of acute and remitting atopic eczema severity designed to help parents and children to monitor and manage eczema, merits further evaluation.

【 授权许可】

   
2013 Mason et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Carroll CL, Balkrishnan R, Feldman SR, Fleischer AB Jr, Manuel JC: The burden of atopic dermatitis: impact on the patient, family, and society. J Invest Dermatol 2005, 22:192-199.
• [2]National Institute for Health and Clinical Excellence: Management of atopic eczema in children from birth up to the age of 12 years. December 2007. http://guidance.nice.org.uk/CG57/Guidance/pdf/English webcite (last accessed 25/04/13
• [3]Kawakami T, Soma Y: Questionnaire survey of the efficacy of emollients for adult patients with atopic dermatitis. J Dermatol 2011, 38:531-535.
• [4]Long CC, Funnell CM, Collard R, Finlay AY: What do members of the national Eczema society really want? Clin Exp Dermatol 1993, 18:516-522.
• [5]Broberg A, Kalimo K, Lindblad B, Swanbeck G: Parental education in the treatment of childhood atopic eczema. Acta Derm Venereol 1990, 70:495-499.
• [6]Cork MJ, Britton J, Butler L, Young S, Murphy R, Keohane SG: Comparison of parent knowledge, therapy utilization and severity of atopic eczema before and after explanation and demonstration of topical therapies by a specialist dermatology nurse. Br J Dermatol 2003, 149:582-589.
• [7]Staab D, Diepgen TL, Fartasch M, Kupfer J, Lob-Corzilius T, Ring J, Scheewe S, Scheidt R, Schmid-Ott G, Schnopp C, Szczepanski R, Werfel T, Wittenmeier M, Wahn U, Gieler U: Age related, structured educational programmes for the management of atopic dermatitis in children and adolescents: multicentre, randomised controlled trial. BMJ 2006, 332:933-938.
• [8]Lawton S: Practical issues for emollient therapy in dry and itchy skin. Br J Nurs 2009, 18:978-984.
• [9]Hanifin JM, Tofte SJ: Patient education in the long-term management of atopic dermatitis. Dermatol Nurs 1999, 11:284-289.
• [10]Coenraads PJ, Span L, Jaspers JP, Fidler V: Intensive patient education and treatment program for young adults with atopic eczema. Hautarzt 2001, 52:428-433.
• [11]Grillo M, Gassner L, Marshman G, Dunn S, Hudson P: Pediatric atopic eczema: the impact of an educational intervention. Pediatr Dermatol 2006, 23:428-436.
• [12]van Os-Medendorp H, Koffijberg H, Eland-de Kok PC, van der Zalm A, de Bruin-Weller MS, Pasmans SG, Ros WJ, Thio HB, Knol MJ, Bruijnzeel-Koomen CA: E-health in caring for patients with atopic dermatitis: a randomized controlled cost-effectiveness study of internet-guided monitoring and online self-management training. Br J Dermatol 2012, 166:1060-1068.
• [13]Palmer CN, Irvine AD, Terron-Kwiatkowski A, Zhao Y, Liao H, et al.: Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet 2006, 38:441-446.
• [14]Cork MJ, Danby SG, Vasilopoulos Y, Hadgraft J, Lane ME, Moustafa M, Guy RH, Macgowan AL, Tazi-Ahnini R, Ward SJ: Epidermal barrier dysfunction in atopic dermatitis. J Invest Dermatol 2009, 129:1892-1908.
• [15]Danby SG, Cork MJ: The skin barrier in atopic dermatitis. In Ch 27 in Harper’s Textbook of Pediatric Dermatology. 3rd edition. Edited by Irvine AD, Hoeger PH, Yan AC. U.K: Blackwell Publishing Ltd; 2011.
• [16]Cork MJ: The importance of skin barrier function. J Derm Treat 1997, 8:S7-S13.
• [17]Hoare C, Li Wan Po A, Williams H: Systematic review of treatments for atopic eczema. Health Technol Assess 2000, 4:1-191.
• [18]Williams HC: Epidemiology of atopic dermatitis. Clin Exp Dermatol 2000, 25:522-529.
• [19]Gruen RL, Weeramanthri TS, Knight SSE, Bailie RS: Specialist outreach clinics in primary care and rural hospital settings. Cochrane Database System Rev 2004, Art. No(1):CD003798. doi:10.1002/14651858.CD003798.pub2
• [20]Kendrick D, Barlow J, Hampshire A, Polnay L, Stewart-Brown S: Parenting interventions for the prevention of unintentional injuries in childhood. Cochrane Database System Rev 2007, Art. No(4):CD006020. doi:10.1002/14651858.CD006020.pub2
• [21]Maas T, Kaper J, Sheikh A, Knottnerus JA, Wesseling G, Dompeling E, Muris JWM, van Schayck CP: Mono and multifaceted inhalant and/or food allergen reduction interventions for preventing asthma in children at high risk of developing asthma. Cochrane Database System Rev 2009, Art. No(3):CD006480. doi:10.1002/14651858.CD006480.pub2
• [22]Components of the patient support programme used in this study are available at http://www.eczemaadvice.co.uk (last accessed 25/04/13)
• [23]Charman CR, Venn AJ, Williams HC: The patient-oriented eczema measure: development and initial validation of a new tool for measuring atopic eczema severity from the patients’ perspective. Arch Dermatol 2004, 140:1513-1519. Erratum in: Arch Dermatol 2005;141:381
• [24]HM GovernmentData.gov.uk. Prescription Cost Analysis: England 2011. http://data.gov.uk/dataset/prescription-cost-analysis-england webcite (last-accessed 25-4-13)
• [25]Curtis L: The unit costs of health and social care 2011. France: University of Kent, PSSRU; 2011. http://www.pssru.ac.uk/archive/pdf/uc/uc2011/uc2011.pdf webcite (last-accessed 25-4-13)
• [26]Pouplard C, Gourraud PA, Meyer N, Livideanu CB, Lahfa M, Mazereeuw-Hautier J, Le Jeunne P, Sabatini AL, Paul C: Are we giving patients enough information on how to use topical treatments? Analysis of 767 prescriptions in psoriasis. Br J Dermatol 2011, 165:1332-1336.