Randomized controlled trial of a single dermatology nurse consultation in primary care on the quality of life of children with atopic eczema

Background Atopic eczema is mostly managed in primary care but there is often insufficient time for patient education; a nurse practitioner could help with this. Objectives To evaluate the effects of a single consultation with a primary care nurse on the quality of life (QOL) of children with atopic eczema aged 0.5-16 years and the impact of the disease on their families. Patients and methods Children with eczema were invited to join the trial. Volunteers were randomized to a control group or an intervention group who attended the nurse for a single 30-min session. Family impact was determined using the Family Dermatitis Index (FDI), and QOL was assessed using the Infant Dermatitis Quality of Life questionnaire (IDQOL) or, in children aged 4-16 years, the Children's Dermatology Life Quality Index (CDLQI). Baseline scores for family impact and QOL were compared with those at 4 weeks and 12 weeks postintervention. Results Two hundred and thirty-five children were recruited over 12 months; 115 were aged 0.5-4 years and 120 were aged 4-16 years. Follow-up data were missing for 38 children (84% completion rate, n=197). All measures of QOL or family impact at baseline were skewed. The median scores were IDQOL, 5, and CDLQI, 6. About 20% of children had zero scores for the FDI (no impact on family life); median FDI scores were 2 or 3. At baseline the FDI correlated with the IDQOL or CDLQI. In addition, the FDI and IDQOL were related to parental assessment of disease severity. Non-responders had, on average, worse QOL at baseline than those who provided complete data. In the children with complete data, the mean differences in CD < Q1 and 1DQO< scores between intervention and control children were small at 4 and 12 weeks (P>0.05). The improvement in FDI at 4 weeks was slightly better in intervention than control children (P<0.06). Conclusions The impact on QOL of a single intervention by a dermatology nurse was marginal for family impact at 4 weeks and was not apparent for other measures, either in the short or longer term. The planned sample size was derived from data in hospital patients but in our population disease activity was milder and the effects on QOL were less. On this account the present study was of low statistical power for some measures. Further studies in larger populations using additional outcome measures are required before advocating the wider introduction of nurse specialists.