Trends in the epidemiology and prescribing of medication for eczema in                England

Simpson, Colin R; Newton, John; Hippisley‐Cox, Julia; Sheikh, Aziz

doi:10.1258/jrsm.2009.080211

Cited by 62 publications

(61 citation statements)

References 22 publications

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“…The methods used to collect primary care data for the QRESEARCH database have been previously described. [9][10][11][12] In the UK, the majority of individuals resident (including children) are registered with primary care, which is free at the point of contact. Patients were included if they were registered on the first day of each year (for example, 1 January 2001) and were registered for the preceding 12 months.…”

Section: Methodsmentioning

confidence: 99%

Trends in the epidemiology of chronic obstructive pulmonary disease in England: a national study of 51 804 patients

Simpson

Hippisley‐Cox

Sheikh³

2010

Br J Gen Pract

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Patients with chronic obstructive pulmonary disease (COPD) constitute a substantial burden to healthcare services. Analysis of national healthcare datasets offers the possibility to advance understanding about the changing epidemiology of COPD. AimTo investigate the epidemiology of physician-diagnosed COPD in general practice. Design of studyCross-sectional study. SettingsA total of 422 general practices in England contributing to the QRESEARCH database. MethodData were extracted on 2.8 million patients, including age, sex, socioeconomic status, and geographical area. Trends over time for recorded physician diagnosis of COPD were analysed (2001)(2002)(2003)(2004)(2005). ResultsThere was little change over time in the incidence rate of COPD (2005: ConclusionGiven the peak in the incidence rate of COPD, we may be approaching the summit of COPD incidence and prevalence in England. However, the number of people affected remains high and poses a major challenge for health services, particularly those in the north east of the country and in the most deprived communities in England. The very limited decrease in smoking rates among the more deprived groups of patients with COPD is also a cause for concern.

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Section: Methodsmentioning

confidence: 99%

Trends in the epidemiology of chronic obstructive pulmonary disease in England: a national study of 51 804 patients

Simpson

Hippisley‐Cox

Sheikh³

2010

Br J Gen Pract

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“…15 In the UK the incidence of eczema has been assessed once, through a large primary care database in 2005; it was found to affect around one in nine people at some point in the year. 16 …”

Section: Background and Aimsmentioning

confidence: 99%

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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BackgroundEczema is a very common chronic inflammatory skin condition.ObjectivesTo update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps.Data sourcesElectronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs).Review methodsStudies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings.ResultsOf 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; andMycobacterium vaccaevaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing.LimitationsThe large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies.ConclusionsAlthough the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…Epidemiological evidence suggests varying prevalence across countries and ethnic groups within populations 2 . It can significantly impact on the quality of life for both child and family 3 and frequently leads to healthcare consultations 4 . It is predominantly diagnosed and treated in the community 5 and managed by parents at home.…”

Section: Introductionmentioning

confidence: 99%

“…A Cochrane review, now being updated, revealed few robust trials evaluating education interventions for child eczema, with some evidence for two models, multidisciplinary teamled education and nurse-led delivery 9 . There is currently no consensus on the optimal models for supporting parents of children with eczema 4 . There is therefore a need for a systematic educational approach to enhance treatment adherence and parental support 9,10 .…”

Section: Introductionmentioning

confidence: 99%

A service evaluation of the Eczema Education Programme: an analysis of child, parent and service impact outcomes

et al. 2013

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Background: The systematic support of parents of children with eczema is essential to their effective management. The few existing support models have a limited evidence base. This paper reports the outcome-orientated service evaluation of an original, extensive social learning theory based, nurse-led Eczema Education Programme (EEP).Objectives: To evaluate the EEP using specified child and parental outcomes and service impact data.Methods: From a sample of 257 parent-child dyads attending the EEP, a pretest-posttest design evaluated its child impact using health related quality of life measures (Infant's Dermatitis Quality of Life index, IDQOL, which includes a small dermatitis severity element; Children's Dermatology Life Quality Index, CDLQI), severity measures (Patient Orientated Eczema Measure, POEM), a new parental measure (Parental Self-Efficacy in Eczema Care Index, PASECI) and service impact data based on General Practice (GP) attendance patterns pre-post intervention.Results: Statistically significant impacts were observed, compared to baseline, on infant quality of life (p<0.001), child quality of life (p=0.027), disease severity (p<0.001) and parental self-efficacy (p<0.001). Improvements in child quality of life, parental efficacy and service impact were also evident from qualitative data. The cumulative total of all GP visits for selected participants post EEP reduced by 62%. Conclusions:The EEP appears to be an effective model of delivering structured education to parents of children with eczema and one generalizable to other multi-ethnic metropolitan populations. As a non-controlled study, this rigorous service evaluation highlights the model's significance and the case for an evaluative multi-centre randomised controlled trial of this educational intervention to inform a nurse-led programme of care.

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Trends in the epidemiology and prescribing of medication for eczema in England

Abstract: SummaryBackground The prevalence of eczema, particularly in younger children, increased substantially over the second half of the 20th century. Analysis of primary healthcare data-sets offers the possibility to advance understanding about the changing epidemiology of eczema.

Cited by 62 publications

References 22 publications

Trends in the epidemiology of chronic obstructive pulmonary disease in England: a national study of 51 804 patients

Trends in the epidemiology of chronic obstructive pulmonary disease in England: a national study of 51 804 patients

Scoping systematic review of treatments for eczema

A service evaluation of the Eczema Education Programme: an analysis of child, parent and service impact outcomes

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