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Acad Pediatr. 2018 Sep - Oct;18(7):789-796. doi: 10.1016/j.acap.2018.02.015. Epub 2018 Mar 2.

A Randomized Controlled Trial of an Eczema Care Plan.

Author information

1
Division of General Pediatrics, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: corinna.rea@childrens.harvard.edu.
2
Division of General Pediatrics, Boston, Mass.
3
Center for Applied Pediatric Quality Metrics, Boston Children's Hospital, Boston, Mass.
4
Harvard Medical School, Boston, Mass; Dermatology Program, Allergy and Immunology Division, Boston Children's Hospital, Boston, Mass.
5
Division of General Pediatrics, Boston, Mass; Harvard Medical School, Boston, Mass.

Abstract

OBJECTIVE:

To test whether an eczema care plan (ECP) would improve provider documentation and management, decrease eczema severity, and increase patient quality of life (QOL) in the pediatric primary care setting.

METHODS:

We conducted a randomized controlled trial from June 2015 to September 2016 at a large hospital-based pediatric primary care clinic. Participants included children from 1 month to 16 years of age with a diagnosis of eczema. The intervention group received the ECP and the control group received usual care. Both groups completed a validated eczema severity scale (Patient-Oriented Eczema Measure [POEM]) and a QOL scale (Infant's Dermatitis Quality of Life Index [IDQOL]) or Children's Dermatology Life Quality Index [CDLQI]) before the visit and again ~1 month later.

RESULTS:

A total of 211 caregivers completed both the pre- and postintervention surveys (100 control group and 111 intervention group [94% completion]). Intervention group providers were more likely to recommend a comprehensive "step-up" plan (88%) vs 28%; P < .001, bleach baths (45%) vs 9%; P < .001, and wet wraps (50%) vs 7%; P < .001. They were also more likely to document providing a written plan to families (80%) vs 2%; P < .001. In the intervention and control groups, eczema severity and QOL improved between the pre- and postintervention periods. However, there was not a significant difference between the groups on either measure: POEM difference -0.8, 95% confidence interval (CI) -3.2 to 1.7; IDQOL difference -0.1, 95% CI -1.8 to 1.6; CDLQI difference 0.8, 95% CI -0.9 to 2.6.

CONCLUSIONS:

Intervention group providers documented more comprehensive eczema care than control group providers. Although patients improved on all measures in the postintervention period, the ECP did not augment that improvement.

KEYWORDS:

atopic dermatitis; dermatology; eczema; eczema care plan; primary care

PMID:
29505898
DOI:
10.1016/j.acap.2018.02.015

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