Background: Parents and carers of children with eczema often underuse emollient therapy, essential to repairing\r\nand protecting the defective skin barrier in atopic eczema. Educational interventions delivered by specialist\r\ndermatology nurses in hospital settings have been shown to improve emollient use and reduce symptoms of\r\natopic eczema, but benefits of community-based interventions are uncertain. Support and information about\r\nappropriate care may often be inadequate for patients and carers in the community.\r\nMethods: A multifaceted educational support programme was evaluated as a method of increasing emollient use\r\nand reducing atopic eczema in children. Support provided for parents and carers included an educational DVD,\r\nonline daily diary and telephone helpline. The before and after study included 136 British children and their parents,\r\nproviding baseline and 12 week follow-up data while receiving the programme. Measures included emollient use,\r\nPOEM and PEST scores, and cost of care.\r\nResults: Average emollient use increased by 87.6 g (95% CI: 81.9 to 119.5 g, p = 0.001) from baseline with the change\r\nbeing immediate and persistent. The POEM score reduced on average by 5.38 (95% CI: 4.36 to 6.41, p = 0.001), a 47%\r\nreduction from baseline. Similarly the PEST score reduced on average by 0.61 (95% CI: 0.47 to 0.75, p = 0.001), a 48%\r\nreduction from baseline. Sleep disturbance was reduced by 1.27 nights per week (95% CI: 0.85 to 1.68, p = 0.001) and\r\nparental feeling of control improved by 1.32 points (95% CI: 1.16 to 1.48, p = 0.001). From the NHS perspective, the\r\nprogramme was cost neutral overall within the study period.\r\nConclusion: A community-based multifaceted educational support programme greatly increased emollient use,\r\nreducing symptoms of atopic eczema and general practitioner contacts, without increasing cost. Significant benefits\r\nmay accrue to the families and carers of children with atopic eczema due to improved sleep patterns and greater\r\nfeeling of control. PEST, a new simple measure of acute and remitting atopic eczema severity designed to help parents\r\nand children to monitor and manage eczema, merits further evaluation.
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