GPs Struggle To Meet Guideline Standards For Atopic Eczema Management

GPs are struggling to provide the quality of care for atopic eczema sufferers currently recommended by both the National Institute of Health and Clinical Excellence (NICE)1 and the Primary Care Dermatology Society/British Association of Dermatologists (PCDS/BAD).2 Almost 90% of GPs recently surveyed reported that they had only limited or insufficient time available to give comprehensive treatment advice, and to demonstrate how to apply critical first-line treatments such as emollients.3 The nation-wide survey of 200 GPs was commissioned by Stiefel Laboratories, the makers of Oilatum, who believe that poor compliance to treatments is a factor in the distress caused by eczema. The study revealed that parents are rarely given written information on how to treat their child’s eczema, and that a lack of parent education is thought to be a key contributor to non-concordance with emollient therapy regimens.3 These results concur with those reported in an earlier survey of over 300 members of the National Eczema Society, which found that over one-third of parents had never received any information from their GPs that had helped them manage their child’s condition.4 They also highlight many of the issues raised in the latest NICE guidelines – published in January – which focus on the importance of good communication between patient and healthcare professional for encouraging medication adherence.5

Atopic eczema guidelines: what are the basic requirements?

The published UK clinical guidelines1,2 set out basic requirements for the primary care management of atopic eczema in children. In both sets of guidelines, the first-line recommended treatment is complete emollient therapy (CET), including continual and liberal use of emollient creams, ointments, bath oils and soap substitutes. Healthcare professionals are advised to take an holistic approach to the management of the condition, and are offered specific guidance on CET including:

· Educating the parent/child on the optimal use emollient therapies; providing details of applications and quantities and, ideally, demonstrating how and when to use them

· Recommending the use of both bath emollients and emollient creams

· Prescribing sufficient quantities of emollient creams, with recommended amounts for a child in the range of 250–500 g per week

· Informing the parent/child that emollients should be used in larger amounts and more often than other treatments – ideally applied at least 3–4-times a day

· Providing written information as a back-up.

Unfortunately, the results from the GP survey suggest that these recommendations are not being followed in all primary care practices. Only 6% of GPs who participated said they always gave parents written information on how to treat their child’s eczema, nearly half admitted they never demonstrated how to apply emollient creams, and over 60% recommended less than the ideal quantity of emollient creams per week. Unsurprisingly, when questioned about the main contributors of non-concordance with emollient therapy regimens, a lack of education about emollient use and insufficient frequency of application were considered by the survey participants to be most likely causes.

Dr Stephen Kownacki, executive chair of the Primary Care Dermagology Society, says he is not especially surpirsed with the results, and acknowledges that there is still considerable room for improvement.

Most GPs will see enough children with atopic dermatitis to know that the condition can be effectively managed with a combination of trigger factor avoidance, proper use of emollient therapies, and early intervention for infections or exacerbations,’ he says. ‘However, it is disappointing that, perhaps because of time constraints, the study shows we are not always providing the level of instruction needed for parents to use CET properly.’

‘This emphasises the need to discuss and demonstrate how emollients should be used, and provide clear and consistent written information whenever possible.’

Stiefel are committed to Dermatology and believe that delivering a patient focused approach to GPs through adherence to the guidelines will aid compliance and lead to improved patient outcomes.

For a free booklet entitled “Take Control of Your Child’s Eczema” please contact Nikki Button at Spink PR on 01444 484888

 

Press Release Suppled With the Kind Permission of Nikki Button at Spink PR

 

Page created: 5 May 2009