Background In the UK, 20–32% of children experience atopic eczema (AE), a chronic inflammatory skin condition typically diagnosed and treated in primary care. Emollient is effective for preventing flare-ups of inflammation and itchiness, topical corticosteroids (TCS) are used for flare-ups. The 2007 National Institute of Health and Clinical Excellence (NICE) guidelines for childhood AE diagnosis and treatment recommend all children presenting with AE in primary care are prescribed emollient; TCS are co-prescribed if indicated by the severity. The proportion of children receiving recommended treatment and NICE guideline impact on prescribing practices is unknown. This study was the first to access SystmOne routine data about UK-wide dermatology consultations in primary care.
We aimed to evaluate treatment patterns of childhood AE against NICE recommendations using routinely collected primary care data from SystmOne.
Methods Secondary analysis of retrospective, longitudinal primary care data for childhood (<12 yo) AE-related consultations from 2004 to 2013. Difference in proportion of consultations per month documenting 4 treatment scenarios was calculated (Wilson Score Method): 1) emollient and TCS co-prescribed (NICE-recommended for moderate or high severity presentation), 2) emollient only (NICE-recommended for mild severity presentation), 3) TCS only (not recommended), or 4) no topical treatment prescribed (not recommended if AE suspected). ARIMA used to examine step and trend-change in prescribing towards NICE-recommended treatment following guideline release.
Results We identified 130,106 children with AE documented at a consultation during the study period. After guideline was released, NICE-recommended treatments increased: emollient and TCS increased 8% (95%CI 7.7,8.7%); emollient only increased 8% (95%CI 7.8,8.8%); TCS only decreased 5% (95%CI -4.2,-5.1%); and no topical treatment decreased 11% (95%CI -11.3,-12.3%).
However, longitudinal analysis revealed there were underlying trends where NICE-recommended prescribing was increasing over time (scenarios 1 and 2), and prescribing not supported by NICE guidelines was decreasing (scenarios 3 and 4). These trends were not significantly affected by the guideline release. Despite these trends, at the end of 2013 ~334 children per month were still not receiving recommended AE treatment (37% of ~900 first-time AE consultations/month).
Conclusion Adherence to best practice guidelines for treatment and management of childhood atopic eczema could be improved. UK routine data can provide insights into the management of chronic conditions in primary care. Improving design of data input interfaces used by health professionals would remove significant barriers to optimal use of the data to answer pressing research questions.
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