Therapeutic patient education in children with moderate to severe atopic dermatitis: A multicenter randomized controlled trial in China

Abstract

Background Therapeutic patient education is a continuous, systematic, patient‐centered learning process to help patients and their families acquire and maintain the skills they need to manage their lives with a chronic disease. It has been proven effective in increasing treatment adherence and improving quality of life for patients with atopic dermatitis (AD) in Western countries. We introduce the first multicenter, randomized controlled clinical trial of therapeutic patient education in Chinese children with AD. Objectives To evaluate the effects of therapeutic patient education on the severity of AD, quality of life, and understanding and successful use of emollients in Chinese children with eczema. Methods We recruited 580 children, ages 2‐14 years, with moderate to severe AD from six hospitals in China. Participants were randomized (1:1) to an intervention (n = 293) or control (n = 249) group. In addition to the severity of AD, data on quality of life and a questionnaire on family and patient knowledge of emollients were evaluated at the 6‐month follow‐up. Results On study completion, we found that the intervention group showed a significantly greater reduction in mean SCORing Atopic Dermatitis (P < .001) and Infant's Dermatology Life Quality Index (P = .030) scores than the control group. In addition, knowledge about the use of emollients improved significantly in the intervention group. There was no significant difference between groups in Children's Dermatology Life Quality Index scores. Conclusions The first randomized controlled trial of a therapeutic patient education program in China had positive long‐term effects on decreasing eczema severity and improvement of quality of life in children 2‐4 years of age with AD, as well as in promoting greater understanding of the use of emollients.

A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease – strategies for optimizing treatment outcome

“…In fact, helping the patient to understand his disease can empower and motivate him to take responsibility for treatment outcome. Therapeutic patient education (TPE) has been shown to increase treatment adherence and outcome in chronic inflammatory skin disease . In a randomized controlled multicentre study, Heratizadeh et al .…”

“…Therapeutic patient education (TPE) 103 has been shown to increase treatment adherence and outcome in chronic inflammatory skin disease. 15,[104][105][106] In a randomized controlled multicentre study, Heratizadeh et al 107 showed that adult patients with atopic dermatitis educated in a 12-h multidisciplinary training programme including dermatological, nutritional and psychological aspects had a significant improvement in their coping behaviour, QoL and disease severity after 1 year of follow-up. Similarly, Reich et al 108,109 developed the Topical Treatment Optimization Programme (TTOP), an educational and supportive intervention for psoriasis patients.…”

Italian guidelines for therapy of atopic dermatitis—Adapted from consensus‐based European guidelines for treatment of atopic eczema (atopic dermatitis)

“…There is good evidence of the benefit from patient education programs mainly delivered by Internet‐based programs. Physicians should explore the disposition of parents, respectively, adult patients toward such programs and, if possible, recommend their use (Liang et al, ; Siebert, Qureshi, Chu, & Goff, ; Yoo, De Gagne, Jeong, & Jeong, ).…”

“…Physicians should explore a possible presence of corticophobia and in relevant cases seek psychological counseling for the patients (respectively, the parents; A, 1a).There is good evidence of the benefit from patient education programs mainly delivered by Internet-based programs. Physicians should explore the disposition of parents, respectively, adult patients toward such programs and, if possible, recommend their use(Liang et al, 2018;Siebert, Qureshi, Chu, & Goff, 2019;Yoo, De Gagne, Jeong, & Jeong, 2018).…”

Pruritus in pediatric patients with atopic dermatitis: a multidisciplinary approach - summary document from an Italian expert group

“…This suggests that in addition to pharmacological treatment, providing educational support to parents is an important factor in achieving a positive long-term outcome. Less benefit for children more than 6 years with moderate or severe eczema has been reported because they become with time less motivated to treat themselves [59], and for this reason the educational program should start as soon as possible.…”