As recent research suggests a 42% rise in eczema during a five year period; could GP’s be doing more?
GPs are struggling to provide the quality of care for children with eczema currently recommended by two of the UK’s most prestigious medical bodies: 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 eczema treatment is responsible for much of the ongoing misery endured by eczema sufferers.
The GP survey also 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 one of the main reasons why emollient therapies are not always used correctly.3 These results agree with those reported in an earlier survey of over 300 members of the National Eczema Society, which found that more than one-third of parents had never received any information from their GPs that had helped them manage their child’s condition.4
What do the eczema guidelines say?
UK eczema guidelines1,2 set out the basic requirements for the management of childhood eczema by primary care teams. 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. GPs and nurses are advised to take an holistic approach to managing the condition, and are offered specific guidance on CET including:
· Educating the parent/child on the optimal use of 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. Not surprisingly, when questioned about why emollient therapies are not always used properly, the GPs surveyed said the most likely causes were a lack of education about how to use them, and them not being applied often enough.
Margaret Cox from the National Eczema Society comment’s, ‘we know from the calls we receive to our helpline that many eczema sufferers are unhappy with the advice they receive from their doctor. I understand that GPs are under increasing pressure and time restraints. However, as the primary health professional the majority of eczema sufferers will first consult about their condition, GP’s are in a perfect position to offer crucial advice that could really make a difference to the lives of sufferers’.
Margaret says that new research suggesting that eczema cases seen by GP’s almost doubled in a four year period, means it’s more vital than ever before that GP’s consider the value of the information they give their patients. She comments ‘GP’s should ensure the time they do have available to spend with eczema suffers should be used to explain the fundamental aspects of treating the condition. From experience, just a few minutes spent to educate and demonstrate how to use emollient treatments effectively and to explain things like the importance of bathing with an emollient bath additive rather than using soaps and detergents can really make a difference to the physical and emotional impact of the condition.
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1. National Institute for Health and Clinical Excellence (NICE). Atopic eczema in children. NICE Clinical Guideline 57. Issue date: December 2007.
2. Primary Care Dermatology Society & British Association of Dermatologists. Guidelines on the Management of Atopic Eczema 2003. Available on-line at: www.bad.org.uk.
3. Survey commissioned by Stiefel Laboratories questioning 200 GPs to investigate the current treatment of eczema. February 2009 GP omnibus survey by Opinion Health.
4. Nationwide survey of childhood eczema by Oilatum® Junior in association with the National Eczema Society. August 2008. Details available at from firstname.lastname@example.org or tel 01444 484888.
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