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Parents, caregivers see value in illustrated eczema action plan

An illustrated eczema action plan (EAP), designed to assist caregivers and patients in the self-management of eczema, appears to be a highly useful tool, researchers report in Journal of Cutaneous Medicine and Surgery (Nov./Dec. 2018; 22(6):577–582).

“For our eczema action plan we want to ensure that the product would be very user friendly for patients and that it would be something they could access easily, that they could understand easily, and that it would function in the ways it is supposed to,” said the study’s senior author, Dr. Michele Ramien, in an interview with The Chronicle of Skin + Allergy.

The EAP was developed to help remind patients of which treatments to use when, as well as a communication tool to inform the patient’s family doctor, as well as the pharmacist filling their prescriptions, said Dr. Ramien, a clinical associate professor at the University of Calgary.

“We thought that by having this tool that is very clear, developed with the input of patients to make sure that it will be valuable and useful for them, that this would help patients and caregivers to manage eczema better,” Dr. Ramien said.

To evaluate the EAP, Dr. Ramien and her colleagues enrolled patients at The Children's Hospital of Eastern Ontario's (CHEO’s) pediatric dermatology clinic in a prospective survey study. Trained research assistants explained the illustrated EAP, and the participants received electronic post-visit survey which included Likert scale questions on usability and satisfaction (nine items) and usefulness (three items).

“If [the EAP] functions the way it is supposed to, it can simplify eczema care for prescribers because it has the prescription laid out in a multistep algorithm based on the severity of eczema—the different products that should be used and different treatments that should be done,” said Dr. Ramien.

“For the patient it gives them a more detailed explanation of how everything is to be used. As you know, dermatology visits are not very long and we know even if you have a long visit that patients only retain about 50 per cent or less of the information they are given during the interview.”

Usability Factor High

In the study, a total of 192 participants were enrolled, and of those, 112 (85 caregivers and 22 patients) completed the post-visit surveys. Patient characteristics were similar between those who responded to treatment and non-responders. Overall, the participants gave positive ratings to the EAP’s usability (96%), satisfaction (85%), and usefulness (78%).

Education level, experience with eczema, previous dermatology consultation, and participant type—whether caregiver or patient—did not significantly affect the usability or usefulness ratings. Caregivers also gave significantly higher overall ratings to the EAP than the patients did (p=0.02).

These results are promising, said Dr. Ramien. “Even patients who were previously experienced with the treatment of eczema still found it very usable and were very satisfied with it. The usefulness was rated slightly lower but all of the measures are really close to 80 per cent or above.”

“I think [the findings] show that this is probably an unmet need in eczema care. That patients are finding this as useful as they did means that there is probably nothing else that we are providing at the current time that fills that need for them.”

The next step will be to evaluate the illustrated EAP for its potential impact on objective measures of eczema severity, as well as on secondary measures of quality of life and retention of eczema information.

“Right now, for example we are looking at the EASI [Eczema Area and Severity Index] and the SCORAD scores for patients at baseline, and then they return for visits at one and three months after receiving either the eczema action plan or routine care in the dermatology clinic,” said Dr. Ramien.

“I think if we can show that there is an objective difference in EASI scores between those two populations then it is an easy sell that this works,” she said.

“But the challenge is that because we selected to do this in a dermatology environment, the difference between the two groups will be less. I predict the difference will be less than if, for example, we used the eczema action plan in an emergency setting where patients receive either an eczema action plan with lots of information on it or teaching from someone that is probably a little less skilled in delivering eczema information at baseline. Because I think even the routine care in a dermatology clinic is quite good.”

Dr. Ramien acknowledges that this work would not have been possible without the participation of medical students, residents, and collaborators including Nordau Kanigsberg and Regis Vaillancourt.

This article originally appeared in the May 2019 issue of The Chronicle of Skin & Allergy.

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