An Online Questionnaire Improves Outcomes for Children With Atopic Eczema.

Background: Atopic dermatitis (AD) is a condition where management can be complicated as it involves significant education about a variety of triggers and treatment options. Access to specialist care for eczema is often limited in many situations, leading parents of children with AD to seek online support for guidance on effective management strategies.

Objective: The intention of the project was to provide an online 'eczema triggers' questionnaire to parents who are waiting for a specialist appointment for their child's eczema. The primary aim was to determine whether using this questionnaire will improve the child's eczema severity as assessed by the SCORing Atopic Dermatitis (SCORAD) clinical tool at the initial appointment. Secondly, to determine if there is a reduced need for a specialist appointment. This can be demonstrated in the form of an increased rate of cancellation in the number of first appointments and/or a decreased need for a review appointment due to improved eczema management and control as a result of completing the online questionnaire.

Methods: A randomised controlled study where families waiting for an appointment for their child with AD were allocated to receive access to an online eczema triggers questionnaire before their appointment or to continue with the standard booking process without a pre-appointment questionnaire. The sample size was calculated to be 100 (50 per group), using 90% power to detect a difference of 10 points in the SCORAD.

Results: There were 119 families assessed for eligibility. One hundred and eight families were randomised, with 55 (49%) assigned to the intervention group. The mean SCORAD score was lower (indicating better eczema outcome) in the intervention group 21.4 (SD: 14.0), compared to the control group 25.2 (SD: 15.6) (mean difference: -3.8 [95% CI: -9.6 to 2.0], p = 0.195). There were 28% (95% CI: 10 to 46, p = 0.003) fewer appointments booked in the intervention group (46%) compared to the control group (74%) at follow up. Under an 'analysis by treatment administered' approach where the group who completed the triggers questionnaire intervention (n = 30) was compared to the control group and the non-completers (n = 74) the difference in mean SCORAD was more pronounced (-8.4 [95% CI: -14.7 to -2.1, p = 0.010]) between the intervention group (mean score 17.3 SD: 12.5) and non-completers (mean score 25.7, SD: 15.2).

Conclusion: The online eczema triggers questionnaire provides positive outcomes in managing a child's AD in the primary care setting, giving access to care and advice whilst waiting for a specialist appointment. The severity of AD upon presentation was found to be less pronounced in individuals who completed the questionnaire, resulting in a reduced need for follow-up appointments. It offers an opportunity to enhance health and well-being outcomes for children and their families whilst also reducing the long-term demand for specialist AD care.