RT Journal Article
SR Electronic
T1 Diagnosis, assessment, and treatment of childhood eczema in primary care: cross-sectional study
JF BJGP Open
JO Br J Gen Pract Open
FD Royal College of General Practitioners
SP bjgpopen17X100821
DO 10.3399/bjgpopen17X100821
VO 1
IS 2
A1 Laureen Jacquet
A1 Daisy M Gaunt
A1 Kirsty Garfield
A1 Matthew J Ridd
YR 2017
UL http://bjgpopen.org/content/1/2/bjgpopen17X100821.abstract
AB Background The majority of children with eczema in the UK are looked after in primary care yet we know little about their care in this setting.Aim To compare the diagnosis, assessment, and treatment of eczema in primary care with published diagnostic criteria and management guidelines.Design & setting Cross-sectional study using data from a randomised controlled feasibility study. General practices, UK.Method Baseline 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.Results Data 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.Conclusion Discrepancies 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.