Etc: Eczema Treatment in Children

Rationale
Atopic eczema (AE) affects ~20% of children and most are managed in primary care. However, we know little about the diagnosis or treatment of childhood AE by general practitioners (GPs). It is thought that GPs under-prescribe emollients and over-use topical corticosteroids (Santer et al 2006). Carers may commonly use complementary or alternative medicines (CAM) or apply significant dietary restrictions, yet GP awareness of or involvement in these decisions is unknown. Possibly four-fifths of the children referred to secondary care (mild or moderate disease severity) could be managed in primary care. Therefore work is required to establish how often children with AE attend their GP (and why), how severe the eczema is from the perspective of both carer and doctor, what treatments are prescribed by doctors and used by carers, and what prompts GP referral to a dermatologist.

Aims & Objectives
Aim: To examine the needs and treatment of children with AE in primary and secondary care.
Objectives:
1) To examine the pattern of health care contacts and factors associated with referral
2) To compare the severity/treatments prescribed in primary and secondary care;
3) To compare clinician and carer assessment of severity;
4) To examine carer use of CAM and dietary exclusions
5) To explore GP knowledge and confidence in managing children with AE.

Methods
Three phase, mixed methods study in primary care:
Phase 1: Carer and GP questionnaires on severity, impact of the condition and treatment; primary care medical record review.
Phase 2: Objective eczema assessment severity of sub-sample. comparisons between the different severity measures and treatments prescribed, identification of factors most strongly associated with referral.
Phase 3: In-depth interviews with GPs to explore doctors’ experience of managing children with eczema. Interviews audio-recorded and transcribed verbatim. Thematic approach to identify the key themes and issues.