Powell Kingsley, Le Roux Emma, Banks Jonathan, Ridd Matthew J
Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK.
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.
BMJ Open. 2018 Feb 15;8(2):e019633. doi: 10.1136/bmjopen-2017-019633.
To compare parents' and clinicians' perspectives on the assessment and treatment of children with eczema in primary care.
Qualitative interview study with purposive and snowball sampling and thematic analysis.
14 general practices in the UK.
11 parents of children with eczema and 15 general practitioners (GPs) took part in semistructured individual interviews.
We identified several areas of dissonance between parents and GPs. First, parents sought a 'cause' of eczema, such as an underlying allergy, whereas GPs looked to manage the symptoms of an incurable condition. Second, parents often judged eczema severity in terms of psychosocial impact, while GPs tended to focus on the appearance of the child's skin. Third, parents sought 'more natural' over-the-counter treatments or complementary medicine, which GPs felt unable to endorse because of their unknown effectiveness and potential harm. Fourth, GPs linked poor outcomes to unrealistic expectations of treatment and low adherence to topical therapy, whereas parents reported persisting with treatment and despondency with its ineffectiveness. Consultations were commonly described by parents as being dominated by the GP, with a lack of involvement in treatment decisions. GPs' management of divergent views varied, but avoidance strategies were often employed.
Divergent views between parents and clinicians regarding the cause and treatment of childhood eczema can probably only be bridged by clinicians actively seeking out opinions and sharing rationale for their approach to treatment. Together with assessing the psychosocial as well as the physical impact of eczema, asking about current or intended use of complementary therapy and involving parents in treatment decisions, the management of eczema and patient outcomes could be improved.
比较家长和临床医生对初级保健中儿童湿疹评估与治疗的看法。
采用目的抽样和滚雪球抽样的定性访谈研究及主题分析。
英国的14家全科诊所。
11名患有湿疹儿童的家长和15名全科医生（GP）参与了半结构化的个人访谈。
我们发现家长和全科医生之间存在几个不一致的方面。首先，家长寻求湿疹的“病因”，如潜在的过敏，而全科医生则着眼于控制一种无法治愈疾病的症状。其次，家长常根据心理社会影响来判断湿疹的严重程度，而全科医生往往关注孩子皮肤的外观。第三，家长寻求“更天然”的非处方治疗或补充药物，全科医生因这些治疗效果未知且有潜在危害而无法认可。第四，全科医生将不良结果与不切实际的治疗期望和局部治疗依从性低联系起来，而家长表示坚持治疗但对其无效感到沮丧。家长普遍认为咨询过程由全科医生主导，自己缺乏参与治疗决策的机会。全科医生对不同观点的处理方式各异，但常采用回避策略。
家长和临床医生在儿童湿疹病因及治疗方面的不同观点，可能只有通过临床医生积极征求意见并分享其治疗方法的理由才能弥合。除了评估湿疹对心理社会和身体的影响、询问补充疗法的当前或预期使用情况以及让家长参与治疗决策外，还可以改善湿疹的管理和患者预后。
