Eczema is a common, long-term condition that usually starts in infancy. It is characterised by dry and itchy skin and is associated with considerable physical, psychological and social morbidity. In the UK, the majority of children are diagnosed and managed exclusively by their General Practitioner (GP). The mainstays of treatment are emollients to improve the hydration of the skin and topical corticosteroids/calcineurin inhibitors to treat or prevent exacerbations or “flares”. Adherence to treatments is poor however. The reason for this is probably multifactorial, but importantly includes parent/carer knowledge and confidence around the use of creams and ointments.
Guidelines promote the use of individualised, self-management plans or “Written Action Plans” (WAPs). WAPs have been the subject of a significant amount of research in children with asthma and have been shown to be beneficial. There are many similarities between eczema and asthma, and limited research into eczema WAPs is promising. However, eczema WAPs have not been subject to rigorous development or evaluation.
This project will produce important systematic reviews of eczema WAPs that will guide future research in this area. These findings will be extended by a novel programme of work establishing, from both user and theoretical perspectives, how and why eczema WAPs in primary care might work. The results of the exploratory study will support the successful development and funding of a definitive trial investigating clinical and cost effectiveness of eczema WAPs
Phase 1: What does previous research tell us about the design, benefits and pitfalls of WAPs in primary care for children with long term conditions such as eczema and asthma?
Phase 2: What are the views of people (parents/carers of children, children with eczema, patient group representatives and health care professionals) involved in the care of children with eczema regarding the content and design of an eczema WAP, and the barriers and facilitators to its use?
Phase 3: What should a feasible, pragmatic randomised controlled trial to evaluate the clinical and cost-effectiveness of eczema WAPs in primary care look like?