Division of General Pediatrics, Boston, Mass; Harvard Medical School, Boston, Mass.
Division of General Pediatrics, Boston, Mass.
Acad Pediatr. 2018 Sep-Oct;18(7):789-796. doi: 10.1016/j.acap.2018.02.015. Epub 2018 Mar 2.
To test whether an eczema care plan (ECP) would improve provider documentation and management, decrease eczema severity, and increase patient quality of life (QOL) in the pediatric primary care setting.
We conducted a randomized controlled trial from June 2015 to September 2016 at a large hospital-based pediatric primary care clinic. Participants included children from 1 month to 16 years of age with a diagnosis of eczema. The intervention group received the ECP and the control group received usual care. Both groups completed a validated eczema severity scale (Patient-Oriented Eczema Measure [POEM]) and a QOL scale (Infant's Dermatitis Quality of Life Index [IDQOL]) or Children's Dermatology Life Quality Index [CDLQI]) before the visit and again ~1 month later.
A total of 211 caregivers completed both the pre- and postintervention surveys (100 control group and 111 intervention group [94% completion]). Intervention group providers were more likely to recommend a comprehensive "step-up" plan (88%) vs 28%; P < .001, bleach baths (45%) vs 9%; P < .001, and wet wraps (50%) vs 7%; P < .001. They were also more likely to document providing a written plan to families (80%) vs 2%; P < .001. In the intervention and control groups, eczema severity and QOL improved between the pre- and postintervention periods. However, there was not a significant difference between the groups on either measure: POEM difference -0.8, 95% confidence interval (CI) -3.2 to 1.7; IDQOL difference -0.1, 95% CI -1.8 to 1.6; CDLQI difference 0.8, 95% CI -0.9 to 2.6.
Intervention group providers documented more comprehensive eczema care than control group providers. Although patients improved on all measures in the postintervention period, the ECP did not augment that improvement.
检验湿疹护理方案（ECP）是否能改善医护人员记录、管理情况，降低湿疹严重程度，提高儿科初级保健环境下患者的生活质量（QOL）。
2015 年 6 月至 2016 年 9 月，我们在一家大型医院儿科初级保健诊所进行了一项随机对照试验。参与者为 1 个月至 16 岁、确诊为湿疹的儿童。干预组接受 ECP，对照组接受常规护理。两组患者在就诊前和大约 1 个月后均使用经验证的湿疹严重程度量表（患者导向湿疹量表[POEM]）和 QOL 量表（婴儿湿疹生活质量指数[IDQOL]）或儿童皮肤病生活质量指数[CDLQI]）进行评分。
共有 211 名照顾者完成了干预前后的调查（对照组 100 人，干预组 111 人[94%完成率]）。与对照组相比，干预组的医护人员更有可能推荐全面的“逐步升级”方案（88% vs 28%；P < .001）、使用漂白浴（45% vs 9%；P < .001）和湿裹疗法（50% vs 7%；P < .001）。他们也更有可能向家属提供书面方案（80% vs 2%；P < .001）。在干预组和对照组中，患者在干预前后的湿疹严重程度和 QOL 均有所改善。然而，两组在这两个指标上均无显著差异：POEM 差值-0.8，95%置信区间（CI）-3.2 至 1.7；IDQOL 差值-0.1，95% CI-1.8 至 1.6；CDLQI 差值 0.8，95% CI-0.9 至 2.6。
干预组医护人员记录的湿疹护理比对照组更全面。尽管患者在干预后所有指标都有所改善，但 ECP 并未增强这种改善。
