A Randomized Controlled Pilot Study of the Effects of an Extra Office Visit on Adherence and Outcomes in Atopic Dermatitis

Sagransky, Matthew J.; Yentzer, Brad A.; Williams, Lisa L.; Clark, Adele; Taylor, Sarah L.; Feldman, Steven R.

doi:10.1001/archdermatol.2010.368

Cited by 39 publications

(28 citation statements)

References 6 publications

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“…This small, unblinded pilot trial, 373 powered to detect large differences in treatment effect, did not find any significant beneficial effect of one extra visit to the doctor. The trial also found no correlation between adherence and reduction in severity and no correlation between baseline severity and adherence, but the study was underpowered to exclude even moderate differences.…”

Section: Overall Implications For Research and Practicementioning

confidence: 66%

“…All participants visited the clinician after 4 weeks of treatment. This pilot trial 373 found a significant improvement in eczema severity assessed by EASI scores, IGA score and participant-assessed itch in both groups, but there were no significant differences between those who had an extra visit to the clinician at 4 weeks and those who did not. The mean difference in percentage improvement in severity measured using EASI scores (extra visit group 76% vs. control group 45%; p = 0.06) showed some difference; however, only 26 out of the 30 participants randomised were included in the analysis.…”

Section: Studiesmentioning

confidence: 74%

“…This trial, by Sagransky and colleagues, 373 reported as a short communication, involved 30 children treated with topical tacrolimus 0.03% daily for 4 weeks. The participants were randomised in an open manner to have either one extra visit to the clinician 1 week after starting treatment or no extra visit.…”

Section: Studiesmentioning

confidence: 99%

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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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Section: Overall Implications For Research and Practicementioning

confidence: 66%

Section: Studiesmentioning

confidence: 74%

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Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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“…Ausgehend von der mangelnden Compliance bei Hautpatienten beschreibt er gezielte und effektive Maßnahmen für eine offenere Haltung der Patienten gegenüber einer Cortison-Behandlung durch häufigere Konsultationen, schriftliche Informationen und das Eingehen auf die Ängste der Patienten. Gerade bei Neurodermitis scheint die gezielte Zuwendung und Aufklärung ein wichtiger Faktor zu sein, um die Therapieeffektivität zu gewährleisten [10,11].…”

Section: Fazit Für Die Praxisunclassified

Bedenken gegenüber topischen Kortikosteroiden: Zuwendung und Patientenaufklärung sind für Therapietreue essenziell

Gieler¹

2017

Kompass Dermatol

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Hintergrund/Ziele: Bedenken gegenüber topischen Kortikosteroiden (TCC; topical corticosteroid concerns) sind bei Patienten mit atopischer Dermatitis ein wichtiges Thema, das mit mangelnder Therapietreue, entsprechend schlechter Krankheitskontrolle und erhöhten Kosten für das Gesundheitswesen einhergeht. Doch weder die Prävalenz von TCC in einer überschaubareren dermatologischen Patientenpopulation noch die Auswirkungen der Patientenaufklärung zu topischen Kortikosteroiden durch Ärzte sind bekannt. Daher untersuchten wir die Prävalenz, Merkmale und Quellen von TCC in einer dermatologischen Population sowie die Auswirkungen schriftlicher und mündlicher Patientenaufklärung über TCC. Methoden: Insgesamt 643 ambulante Patienten mit verschiedenen Hautkrankheiten beantworteten während der Wartezeit in der Praxis einen Fragebogen mit 12 Items. Vor und nach der Patienteninformation, bestehend aus einer schriftlichen und mündlichen dermatologischen Aufklärung über topische Kortikosteroide (TCS), stuften die Patienten mit TCC das Ausmaß ihrer Bedenken auf einer separaten visuellen Analogskala ein. Ergebnisse: Die TCC-Prävalenz lag bei 41,5%; die Prävalenz TCC-bedingter Non-Adhärenz bei 28,3%. TCC war positiv assoziiert mit einem Lebensalter <60 Jahren, weiblichem Geschlecht, Anwendung von Komplementär- und Alternativmedizin (CAM) sowie Inanspruchnahme von nicht-ärztlicher Gesundheitsberatung. Die stärksten Bedenken bestanden gegenüber Hautatrophie, systemischen Wirkungen und Beeinträchtigungen des Immunsystems. Die häufigsten Quellen von TCC waren negative Berichte in den Medien oder von Angehörigen und Freunden. Sowohl die schriftliche als auch die mündliche Aufklärung reduzierten die TCC signifikant. Die «number needed to benefit from (patient) information» betrug für die Patientenaufklärung etwa 2. Die Non-Responder waren überdurchschnittlich häufig weiblich, TCS-unerfahren, CAM-Anwender und von mittlerem Bildungsniveau. Schlussfolgerungen: TCC sind in bei dermatologischen Patienten sehr weit verbreitet. Die Aufklärung des Patienten kann die TCC in nahezu jedem zweiten Fall reduzieren.

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“…Attempting to improve adherence to the treatment regimen is also important. One study found frequent follow-up visits may be one potentially useful strategy [ 56 ] .…”

Section: Therapeutic Overviewmentioning

confidence: 99%

Update on Atopic Eczema with Special Focus on Dryness and the Impact of Moisturizers

Simpson

2012

Treatment of Dry Skin Syndrome

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A Randomized Controlled Pilot Study of the Effects of an Extra Office Visit on Adherence and Outcomes in Atopic Dermatitis

Abstract: Dr Hillhouse had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Baker and Hillhouse. Acquisition of data: Hillhouse.

Cited by 39 publications

References 6 publications

Scoping systematic review of treatments for eczema

Scoping systematic review of treatments for eczema

Bedenken gegenüber topischen Kortikosteroiden: Zuwendung und Patientenaufklärung sind für Therapietreue essenziell

Update on Atopic Eczema with Special Focus on Dryness and the Impact of Moisturizers

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