Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol.
National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Br J Gen Pract. 2018 Feb;68(667):e73-e80. doi: 10.3399/bjgp18X694529. Epub 2018 Jan 15.
Eczema is common among children, and in the UK the majority are managed by GPs. The most common cause of poor disease control is incorrect use of topical treatments. There is a lack of research into the challenges faced by GPs in diagnosing and managing this condition.
To explore the experiences of GPs in assessing and managing children with eczema.
Qualitative study in primary care in England.
Semi-structured interviews with 15 GPs were audiorecorded, transcribed verbatim, and analysed thematically using the framework method.
GPs described a paucity of dermatology training. Although most GPs were confident diagnosing uncomplicated eczema, they reported using a trial-and-error approach to prescribing emollients, and were uncertain about quantities of topical treatments to issue. Mild and moderate potency topical corticosteroids (TCS) were commonly used, but most GPs lacked confidence in recommending potent TCS, and viewed parents or carers to be fearful of using all strengths of TCS. GPs perceived adherence to treatments to be low, but provision of information to support self-care was variable. Routine review of medication use or disease control was uncommon, which GPs attributed to service constraints. Participants' views on the causes and management of eczema were perceived to be at odds with parents and carers, who were said to be overly focused on an underlying cause, such as allergy.
GP uncertainty in managing eczema, lack of routine information and review, and perceived dissonance with parents around causation and management may be contributing to low concordance with treatments.
湿疹在儿童中很常见，在英国，大多数儿童由全科医生管理。导致疾病控制不佳的最常见原因是外用药物治疗使用不当。对于全科医生在诊断和管理这种疾病时所面临的挑战，研究甚少。
探讨全科医生评估和管理湿疹儿童的经验。
在英格兰的基层医疗中进行的定性研究。
对 15 名全科医生进行半结构化访谈，录音，逐字转录，并使用框架方法进行主题分析。
全科医生描述了皮肤科培训的不足。尽管大多数全科医生对诊断单纯性湿疹有信心，但他们报告说，在开具保湿剂时采用试错法，并且不确定要开出多少剂量的外用药物。轻度和中度强度的外用皮质类固醇（TCS）通常被使用，但大多数全科医生对推荐强效 TCS 缺乏信心，并且认为家长或照顾者害怕使用所有强度的 TCS。全科医生认为治疗的依从性低，但提供支持自我护理的信息存在差异。常规审查药物使用或疾病控制并不常见，全科医生将其归因于服务限制。参与者对湿疹的病因和治疗的看法与家长和照顾者的看法不一致，家长和照顾者过于关注潜在病因，如过敏。
全科医生在管理湿疹方面的不确定性、缺乏常规信息和审查，以及与家长在病因和治疗方面的感知差异，可能导致治疗的一致性降低。
