Joining up eczema: primary care practitioners and their roles
Today, writer Jean Robinson will talk about the role of primary care professionals in managing eczema and the commissioning of eczema services
Posted: 29 January 2016
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All primary care practitioners need to be familiar with national guidelines on the assessment and management of childhood eczema.
GPs need to assess severity of eczema accurately and prescribe sufficient quantities of emollients (and TCS where indicated) as this is an area where parents often report problems. Prescriptions should avoid over complicated treatment regimes. Babies with moderate or severe eczema should be monitored for food allergies. Bacterial skin infections should be treated. Referral to health visitors or community nursery nurses for further education and support should be considered particularly for children with more severe disease and those who attend appointments frequently. Quality of life should be monitored.
Parents often experience barriers in the delivery of treatment with child resistance to treatment. Some experience “cream wars” that can result in attempts to disguise treatments eg putting bath additives in different bottles, applying treatments when the child is asleep, restraining the child or reducing applications. Health visitors should help with practical advice about more positive strategies eg games, rewards and distraction, explaining and involving the child in the treatment and helping parents to develop achievable routines.
Babies with moderate or severe eczema should be monitored for non IgE mediated symptoms and poor growth.
School nurses should agree written healthcare plans with parents and facilitate the application of moisturiser at school with appropriate adult input and supervision as well as guiding parents to see their child’s GP if a child’s attendance and progress are being negatively affected. Referrals can also be made to community children’s nurses.
Community Children’s Nurses
Community children’s nurses deliver support,education and training of parents and carers about steps they can take in the home environment to manage eczema. They achieve this through problem solving and solution finding to help families overcome barriers they experience in caring for their child’s eczema. Knowledgeable and confident parents can improve the outcomes for the children.
The Pharmacy First scheme may mean pharmacists are the first to see the child so an ability to assess severity and educate parents in the use of emollients is essential. As the dispenser of prescriptions it is essential they educate parents in the use of TCS.
Commissioning eczema services
Commissioners could improve the care of children with eczema (NICE 2013) by:
• Nomination of a lead dermatology commissioner to raise awareness and monitor improvements to children’s dermatology pathways
• Commissioning dermatology education for all practitioners. Currently the Royal College of General Practitioner’s (RCGP) curriculum statement Care of Children and Young People does not reference eczema. Education of health visitors, school nurses and community children’s nurses is not formalised. Multi-disciplinary education would aid working relationships and increase GPs’ knowledge and confidence in others’ roles. Dermatology specialists must be involved in the development of education programmes
• Engage with GPs at practice level to maintain and increase referrals to community children’s nurse teams to reduce secondary care referrals and attendances by providing additional time for education for families and helping to triage referrals to secondary care
• Develop a local formulary for eczema prescribing for children. Assess local prescribing practice working with pharmacy and medicines management services to ensure that the local formulary includes an appropriate range of emollients and treatments. This should include advice on the quantity to prescribe, recommended first-choice treatments and exclusions
• Ensure there is a pathway for children with eczema who need referral for specialist psychological advice
• Ensure there is a pathway that has a named healthcare professional who can offer specialist allergy advice.
With thanks to Drs Sasha Dhoat, Lee Noimark and David Paige