Cork M J, Britton J, Butler L, Young S, Murphy R, Keohane S G
Paediatric Dermatology Clinic, Sheffield Children's Hospital, Sheffield S10 2TH, UK.
Br J Dermatol. 2003 Sep;149(3):582-9. doi: 10.1046/j.1365-2133.2003.05595.x.
The failure of patients to take medicines in a way that leads to clinical benefit is a major challenge. A consensus has emerged that, on average, compliance sufficient to obtain therapeutic objectives occurs about half the time, with noncompliance contributing to therapeutic failure in the other half. These figures refer to simple oral regimens. There has been little work assessing compliance/concordance with complex treatment regimens for atopic eczema. Asthma schools led by specialist nurses have been shown to improve knowledge, use of therapies and clinical outcome.
To determine the effect of education and demonstration of topical therapies by specialist dermatology nurses on therapy utilization and severity of atopic eczema.
Fifty-one children with atopic eczema attending a paediatric dermatology clinic were followed for up to 1 year. At each visit the parent's knowledge about atopic eczema and its treatment and therapy utilization was recorded. The severity of the eczema was recorded using the six area, six sign atopic dermatitis severity score (SASSAD) and parental assessment of itch, sleep disturbance and irritability. At the first visit a specialist dermatology nurse explained and demonstrated how to use all of the topical treatments. This education was repeated at subsequent visits depending on the knowledge of the parent.
At baseline less than 5% of parents had received/recalled receiving any explanation of the causes of eczema or demonstration of how to apply topical treatments. The eczema was poorly controlled in all children (mean SASSAD 42.9). Of the children, 24% were not being treated with any emollient cream/ointment; the mean use was 54 g weekly. Of the children, 25% were being inappropriately treated with potent or very potent topical steroids. Following repeated education and demonstration of topical therapies by a specialist dermatology nurse, there was an 89% reduction in the severity of the eczema. The main change in therapy utilization was an 800% increase in the use of emollients (to 426 g weekly of emollient cream/ointment) and no overall increase in the use of topical steroids, accounting for potency and quantity used.
This study reinforces the importance of specialist dermatology nurses in the management of atopic eczema. It also confirms the opinion of patients, patient support groups, dermatologists and best practice guidelines that the most important intervention in the management of atopic eczema is to spend time to listen and explain its causes and demonstrate how to apply topical therapies.
患者未能以实现临床获益的方式服药是一项重大挑战。已形成一种共识，即平均而言，足以实现治疗目标的依从性仅在约一半的时间内出现，另一半时间的治疗失败则归因于不依从。这些数据针对的是简单的口服治疗方案。对于特应性皮炎复杂治疗方案的依从性/一致性评估工作很少。由专科护士主导的哮喘学校已被证明可提高知识水平、治疗方法的使用及临床结局。
确定皮肤科专科护士对局部治疗的教育和示范对特应性皮炎治疗的利用情况及严重程度的影响。
对51名在儿科皮肤科诊所就诊的特应性皮炎患儿进行了长达1年的随访。每次就诊时，记录家长对特应性皮炎及其治疗和治疗利用情况的了解。使用六区域、六体征特应性皮炎严重程度评分（SASSAD）记录湿疹的严重程度，并记录家长对瘙痒、睡眠障碍和易怒情况的评估。在首次就诊时，皮肤科专科护士解释并示范了如何使用所有局部治疗方法。根据家长的知识水平，在后续就诊时重复进行这种教育。
在基线时，不到5%的家长接受过/回忆起接受过关于湿疹病因的任何解释或如何应用局部治疗的示范。所有患儿的湿疹控制不佳（平均SASSAD为42.9）。在这些患儿中，24%未接受任何润肤霜/软膏治疗；平均每周使用量为54克。在这些患儿中，25%接受了强效或超强效局部类固醇的不恰当治疗。在皮肤科专科护士对局部治疗进行反复教育和示范后，湿疹严重程度降低了89%。治疗利用情况的主要变化是润肤剂的使用增加了800%（达到每周426克润肤霜/软膏），并且局部类固醇的总体使用量没有增加，综合考虑了使用的效力和数量。
本研究强化了皮肤科专科护士在特应性皮炎管理中的重要性。它还证实了患者、患者支持团体、皮肤科医生和最佳实践指南的观点，即在特应性皮炎管理中最重要的干预措施是花时间倾听并解释其病因，并示范如何应用局部治疗。
