Improving patient education for atopic dermatitis: A randomized controlled trial of a caregiver handbook.

BACKGROUND/OBJECTIVES: Patient education is important to families' ability to manage and cope with pediatric atopic dermatitis (AD). We evaluated whether an educational handbook could improve AD symptoms, caregiver confidence in AD management skills, and AD-related quality of life. METHODS: Caregivers of children with AD ages 1 month to 16 years were randomly assigned to the intervention arm (handbook in addition to standard AD management) or the control arm (standard management alone). Caregivers completed self-report outcome questionnaires prior to a clinical visit for AD and at 3-month follow-up. RESULTS: 175 caregivers completed questionnaires at baseline and follow-up. AD symptoms measured by the Patient-Oriented Eczema Measure (POEM) improved in both the handbook and control arms. However, the decrease in the mean POEM score in the handbook arm (-4.4, 95% CI [-5.8, -3.0]) did not differ from that in the control arm (-3.4, 95% CI [-4.8, -2.03]; P = .343). Change in quality of life did not differ between study arms. Among caregivers attending a new patient visit for AD, mean confidence scores (measured from 0 to 100) increased more in the handbook arm (67 [95% CI {60, 74}] to 83 [95% CI {77, 88}]) relative to the control arm (74 [95% CI {65, 82}] to 75 [95% CI {67, 83}]; P = .012). The majority of caregivers rated the handbook as helpful in managing the child's AD. CONCLUSIONS: Despite an adequate sample size, the handbook did not improve AD symptoms more than standard management alone. The handbook improved confidence in management skills for families attending new patient visits for AD.

Implementation of a Standardized Clinical Assessment and Management Plan (SCAMP) for Food Challenges.

BACKGROUND: Oral food challenges (OFCs) are routinely used to confirm ongoing food allergy. Serum-specific IgE (sIgE) and skin prick testing (SPT) are imperfect predictors of which patients will pass OFCs. OBJECTIVE: The objective of this study was to describe the design and implementation of a Standardized Clinical Assessment and Management Plan (SCAMP) to study and iteratively improve sIgE and SPT thresholds to determine when and where to conduct OFCs for patients. METHODS: Allergists consulted recommended sIgE and SPT thresholds when ordering challenges although diversions were permitted. Criteria were iteratively improved after periodic analyses of challenge outcome and diversions. RESULTS: Over 3 years, allergists ordered 2368 food challenges for 1580 patients with histories of IgE-mediated reactions to food: 1386 in an outpatient clinic and 945 in a higher resource infusion center. Reactions to challenge were observed in 13% of clinic and 23% of infusion center challenges. Six patients challenged in clinic required treatment with epinephrine compared with 22 in the infusion center. The need for epinephrine was more common in patients with asthma-5% of asthmatic patients required epinephrine compared with 1% of nonasthmatic patients (P < .01). Recommended sIgE and SPT thresholds were incrementally changed and, using the control chart methodology, a significant decrease was noted in the proportion of challenges ordered in the higher resource location. CONCLUSIONS: By setting and continually refining sIgE and SPT recommendations using the SCAMP method, allergists can better determine the risk of severe reaction and triage patients to the appropriate setting for an OFC.

Multidisciplinary interventions in the management of atopic dermatitis.

Atopic dermatitis (AD) is the most common pediatric skin disease. AD has a significant effect on patient and family quality of life caused by intense pruritus, sleep disruption, dietary and nutritional concerns, and psychological stress associated with the disease and its management. Multidisciplinary approaches to AD care have been developed in appreciation of the complex interplay among biological, psychological, behavioral, and dietary factors that affect disease control and the wide range of knowledge, skills, and support that patients and families require to effectively manage and cope with this condition. Common components of multidisciplinary treatment approaches include medical evaluation and management by an AD specialist, education and nursing care, psychological and behavioral support, and nutritional assessment and guidance. Models of care include both clinical programs and structured educational groups provided as adjuncts to standard clinical care. Available evidence suggests beneficial effects of multidisciplinary interventions in improving disease severity and quality of life, particularly for patients with moderate-to-severe disease. Additional research is needed to identify the best candidates for the various multidisciplinary approaches and evaluate the cost-effectiveness of these programs.

A Review of Multidisciplinary Interventions in Atopic Dermatitis.

Multidisciplinary interventions have been developed for patients with atopic dermatitis (AD) and their families, with the aim of improving outcomes such as disease control, adherence, and quality of life. We reviewed the content of different multidisciplinary approaches to intervention for AD and evidence for their impact on key outcome measures. We also provided data from our multidisciplinary outpatient program for pediatric AD. Studies included in the review suggest benefits of multidisciplinary interventions as models of treatment or adjuncts to standard medical care, with a positive impact on outcomes including disease severity and itching/scratching. There were limitations to existing studies, including heterogeneous methods used to assess quality of life outcomes across studies and lack of controlled studies assessing the outcome of clinical care programs. Further research will be useful in assessing the impact of multidisciplinary interventions on important outcomes such as treatment adherence and sleep, identifying the elements of multidisciplinary interventions that are most critical for improved outcomes, and identifying the best candidates for multidisciplinary intervention approaches.

Clinical management of atopic dermatitis: practical highlights and updates from the atopic dermatitis practice parameter 2012.

Atopic dermatitis is a challenging condition for clinicians and patients. Recent advances were documented in the Atopic Dermatitis Practice Parameter 2012, and we want to provide clinicians with key points from the Atopic Dermatitis Practice Parameter 2012. In this article, we highlight the evidence-based therapy of atopic dermatitis as well as provide practical tips for clinicians and families. An updated review of immunopathology provides a firm basis for patient education and therapy. We also review clinical diagnosis and ways to improve quality of life for patients with atopic dermatitis.

Predictors of clinical success in a multidisciplinary model of atopic dermatitis treatment.

Atopic dermatitis (AD) is one of the most common pediatric skin disorders. Because treatment involves allergen avoidance, dietary changes, and behavior modification, multidisciplinary treatment models have been used to complement conventional medication therapy. However, predictors of clinical response in these multidisciplinary models have not been studied. This study examined factors associated with a reduction in AD severity in a multidisciplinary outpatient pediatric AD treatment program providing medical, nutritional, and behavioral support. Data were collected from 170 patients between 2001 and 2006. The Eczema Area and Severity Index (EASI) score was determined at the time of each visit. Using a logistic regression model, we investigated the association of baseline demographic and clinical characteristics with clinical outcome. We also analyzed the association between improvement in the EASI score and behavioral changes. One hundred thirty-eight patients had significantly improved EASI scores, and 32 patients were nonresponders. Responders had a median improvement of 79% in their EASI score, whereas nonresponders had a 53% worsening of their EASI score (p < 0.0001) and a significantly worse absolute EASI score (p < 0.001). Predictors of clinical success included baseline EASI score, baseline age, and improved parental adherence to treatment recommendations. Improvement in the EASI score significantly correlated with quality-of-life measures: decreased itching and scratching, difficulty sleeping, and parental concerns about side effects. A multidisciplinary model of AD treatment has the best clinical outcomes in younger patients with severe AD. Ensuring parental compliance with treatment recommendations is important for clinical response.

Evaluation of a group intervention for children with food allergy and their parents.

BACKGROUND: Children with food allergy and their parents may experience substantial stress related to the risk of serious reactions and the demands of allergy management. OBJECTIVE: To evaluate a group intervention for children with food allergy and their parents designed to increase parent-perceived competence in coping with food allergy and to decrease the parent-perceived burden associated with food allergy. METHODS: Sixty-one children aged 5 to 7 years with food allergy and their parents attended 1 of 4 half-day workshops, with parent and child groups run concurrently. Parents completed self-report measures of perceived competence in coping with food allergy at 3 time points: preworkshop (within 8 weeks of the intervention), postworkshop (immediately after the intervention), and follow-up (4-8 weeks after the intervention). Parents completed a measure of burden associated with food allergy at preworkshop and follow-up. Parents and children also completed evaluations of the study intervention. RESULTS: Parent-perceived competence in coping with food allergy increased significantly from preworkshop to postworkshop and follow-up, and parent-perceived burden associated with food allergy decreased from preworkshop to follow-up. Parent and child evaluations of the workshop were favorable. CONCLUSIONS: These findings provide preliminary support for the effectiveness and feasibility of a group intervention for children with food allergy and their parents and suggest the importance of controlled evaluations of group interventions in this population in the future.

Integrating medical and psychological health care for children with atopic dermatitis.

OBJECTIVE: To present descriptive data from a hospital-based interdisciplinary program that provides integrated medical and psychological health-care for children with atopic dermatitis (AD). METHODS: Clinical records were reviewed for 69 children seen in our program to examine parent-reported AD-related presenting concerns, as well as common problems and interventions addressed during family visits with the program psychologist. RESULTS: The most common presenting concerns included child itching and scratching and associated sleep problems. Parent initial request for a meeting with the program psychologist was not related to child disease severity, but was associated with child sleep problems and parent emotional and practical challenges in managing the child's condition. CONCLUSIONS: Results support the need for, acceptance of, and feasibility of providing integrated care for children with AD and their families. Changes to our clinical model based on study findings are discussed.