Exploring the Effect of Nice Guidelines on Prescribing for Childhood Atopic Eczema in Primary Care with An Interrupted Time Series
Introduction Atopic eczema (AE) is a chronic inflammatory skin condition affecting 20-32% of UK children, typically diagnosed and treated in primary care. National Institute of Health and Clinical Excellence (NICE, 2007) guidelines recommend all children presenting with AE in primary care are prescr...
| 主要な著者: | , , |
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| フォーマット: | 論文 |
| 言語: | English |
| 出版事項: |
Swansea University
2020-12-01
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| シリーズ: | International Journal of Population Data Science |
| オンライン･アクセス: | https://ijpds.org/article/view/1613 |
| _version_ | 1827613772255068160 |
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| author | LIW Schreuders SJ Ersser C Thompson |
| author_facet | LIW Schreuders SJ Ersser C Thompson |
| author_sort | LIW Schreuders |
| collection | DOAJ |
| description | Introduction
Atopic eczema (AE) is a chronic inflammatory skin condition affecting 20-32% of UK children, typically diagnosed and treated in primary care. National Institute of Health and Clinical Excellence (NICE, 2007) guidelines recommend all children presenting with AE in primary care are prescribed emollient; topical corticosteroids (TCS) are co-prescribed if indicated by severity. The proportion of children receiving recommended treatment and NICE guideline impact on prescribing practices is unknown. This study was the first to access population-level UK-wide primary care dermatology data from SystmOne.
Objectives and Approach
We explored treatment patterns for childhood AE documented in primary care data from SystmOne.
Secondary analysis of retrospective, longitudinal primary care data for childhood (<12yo) AE-related consultations from 2002 to 2013. Four treatment scenarios were compared: 1) emollient and TCS co-prescribed (NICE-recommended for moderate-high severity presentation), 2) emollient only (NICE-recommended for mild severity presentation), 3) TCS only (not recommended), or 4) no topical treatment prescribed (not recommended). ARIMA used to examine step and trend-change in prescribing following guideline release.
Results
NICE-recommended treatments were more common following guideline release: emollient+TCS increased 8% (95%CI 7.7,8.7%); emollient alone increased 8% (95%CI 7.8,8.8%); TCS alone decreased 5% (95%CI -4.2,-5.1%); and no treatment decreased 11% (95%CI -11.3,-12.3%).
Longitudinal analysis indicated increased NICE-recommended prescribing was due to pre-existing trends not significantly altered by the guideline release. By December 2013, ~334 children per month were still not receiving recommended AE treatment (37% of ~900 first-time consultations/month).
Conclusion / Implications
Adherence to best practice guidelines for treatment and management of childhood atopic eczema is currently sub-optimal. Significant barriers to optimal use of this data could be achieved by improving design of data input interfaces with secondary use for research in mind. As well as study findings, this presentation will share challenges associated with utilising routinely collected SystmOne data for research purposes for the first time in the UK. |
| first_indexed | 2024-03-09T08:44:27Z |
| format | Article |
| id | doaj.art-f7173f57776f45f89f9a00be52718b9e |
| institution | Directory Open Access Journal |
| issn | 2399-4908 |
| language | English |
| last_indexed | 2024-03-09T08:44:27Z |
| publishDate | 2020-12-01 |
| publisher | Swansea University |
| record_format | Article |
| series | International Journal of Population Data Science |
| spelling | doaj.art-f7173f57776f45f89f9a00be52718b9e2023-12-02T15:51:58ZengSwansea UniversityInternational Journal of Population Data Science2399-49082020-12-015510.23889/ijpds.v5i5.1613Exploring the Effect of Nice Guidelines on Prescribing for Childhood Atopic Eczema in Primary Care with An Interrupted Time SeriesLIW Schreuders0SJ Ersser1C Thompson2University of LeedsBournemouth UniversityUniversity of LeedsIntroduction Atopic eczema (AE) is a chronic inflammatory skin condition affecting 20-32% of UK children, typically diagnosed and treated in primary care. National Institute of Health and Clinical Excellence (NICE, 2007) guidelines recommend all children presenting with AE in primary care are prescribed emollient; topical corticosteroids (TCS) are co-prescribed if indicated by severity. The proportion of children receiving recommended treatment and NICE guideline impact on prescribing practices is unknown. This study was the first to access population-level UK-wide primary care dermatology data from SystmOne. Objectives and Approach We explored treatment patterns for childhood AE documented in primary care data from SystmOne. Secondary analysis of retrospective, longitudinal primary care data for childhood (<12yo) AE-related consultations from 2002 to 2013. Four treatment scenarios were compared: 1) emollient and TCS co-prescribed (NICE-recommended for moderate-high severity presentation), 2) emollient only (NICE-recommended for mild severity presentation), 3) TCS only (not recommended), or 4) no topical treatment prescribed (not recommended). ARIMA used to examine step and trend-change in prescribing following guideline release. Results NICE-recommended treatments were more common following guideline release: emollient+TCS increased 8% (95%CI 7.7,8.7%); emollient alone increased 8% (95%CI 7.8,8.8%); TCS alone decreased 5% (95%CI -4.2,-5.1%); and no treatment decreased 11% (95%CI -11.3,-12.3%). Longitudinal analysis indicated increased NICE-recommended prescribing was due to pre-existing trends not significantly altered by the guideline release. By December 2013, ~334 children per month were still not receiving recommended AE treatment (37% of ~900 first-time consultations/month). Conclusion / Implications Adherence to best practice guidelines for treatment and management of childhood atopic eczema is currently sub-optimal. Significant barriers to optimal use of this data could be achieved by improving design of data input interfaces with secondary use for research in mind. As well as study findings, this presentation will share challenges associated with utilising routinely collected SystmOne data for research purposes for the first time in the UK.https://ijpds.org/article/view/1613 |
| spellingShingle | LIW Schreuders SJ Ersser C Thompson Exploring the Effect of Nice Guidelines on Prescribing for Childhood Atopic Eczema in Primary Care with An Interrupted Time Series International Journal of Population Data Science |
| title | Exploring the Effect of Nice Guidelines on Prescribing for Childhood Atopic Eczema in Primary Care with An Interrupted Time Series |
| title_full | Exploring the Effect of Nice Guidelines on Prescribing for Childhood Atopic Eczema in Primary Care with An Interrupted Time Series |
| title_fullStr | Exploring the Effect of Nice Guidelines on Prescribing for Childhood Atopic Eczema in Primary Care with An Interrupted Time Series |
| title_full_unstemmed | Exploring the Effect of Nice Guidelines on Prescribing for Childhood Atopic Eczema in Primary Care with An Interrupted Time Series |
| title_short | Exploring the Effect of Nice Guidelines on Prescribing for Childhood Atopic Eczema in Primary Care with An Interrupted Time Series |
| title_sort | exploring the effect of nice guidelines on prescribing for childhood atopic eczema in primary care with an interrupted time series |
| url | https://ijpds.org/article/view/1613 |
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