Development and Evaluation of an Atopic Dermatitis Care Plan for Providers

October 2020 | Volume 19 | Issue 10 | Original Article | 950 | Copyright © October 2020


Published online September 16, 2020

Collette Utley DNP FNP-BC PNP-BCa, Michael H. Gold MD FAADa, Melissa Hall DNP FNP-BC AGPNP-BCb

aGold Skin Care Center, Nashville, TN bUniversity of Southern Indiana, Evansville, IN

Abstract
Background/Significance of problem: Atopic Dermatitis (AD) is a common, chronic, inflammatory dermatosis and skin disease that follows a relapsing pattern and requires a dynamic stepwise approach to management.Providers feel comfortable treating chronic disease states with a guided tool or care plan in many chronic diseases.Care plans used in many chronic diseases such as asthma, diabetes, and COPD have demonstrated effectiveness in disease and healthcare provider management.There is an unmet need for a universal AD care plan for providers.

Clinical question/project purpose: A universal AD care plan was developed to improve AD disease management and patient outcomes. Post-implementation of providers’ perceptions was assessed for how the AD universal care plan affected their ability to provide patient education.

Search of literature/best evidence
: Review of literature includes: CINAHL, ProQuest Health, PubMed, Fusion, and UpToDate databases from 2008-2018.Search terms included: Atopic Dermatitis, Eczema, care plans, care plan use in chronic disease.

Clinical appraisal of literature/best evidence
: Analysis of the evidence supported the need for AD education, which then supported the need for a universal AD care plan for providers.

Integration into practice
: “Your Eczema Care Plan” was used by thirty-five healthcare providers to improve patient outcomes in a similar manner as other evidence-based care plans.

Evaluation of evidenced-based practice
: Post-implementation of providers’ perceptions were evaluated on how the AD care plan tool affected their ability to provide patient education. Results suggest patient education, disease management, and QOL are all improved when utilizing “Your Eczema Action Plan.”

J Drugs Dermatol. 2020;19(10): 950-955. doi:10.36849/JDD.2020.5090

INTRODUCTION

Atopic Dermatitis (AD) is a common, chronic, inflammatory dermatosis and skin disease that follows a relapsing pattern and requires a dynamic and stepwise approach to management.1,2 AD is often associated with an elevated serum immunoglobulin (IgE), familial or personal history of type 1 allergies associated with anaphylaxis, asthma, and allergic rhinitis.3-6 Some consider AD as the start of the “atopic march”, which is defined as the development of AD in infancy and subsequently allergic rhinitis and asthma later in childhood.7,5-6 According to Lyons et al,6 “education of the underlying and primary defects, as well as provision of a comprehensive skin care plan, are essential in management of disease flares and disease maintenance in AD” (p.161). Care plan use in many chronic diseases such as asthma, diabetes, arthritis, and COPD have demonstrated effectiveness in disease management.8,1,5,9,10-12 An AD care plan is a guided tool to assist providers in educating patients on AD.

Co-Morbidities, Incidence and Financial Impact of AD
According to a study by Roduit et al4 early phenotypes among children with AD (before age two) identified a correlation of food allergies and asthma by the age of six. AD most commonly affects children more often than adults. Onset is most common between three to six months of age. Approximately 60% of children develop AD by their first year of life, while 90% develop AD by five years. Twenty five percent of children younger than 14 years of age are affected compared to two to three percent of adults.3,13,5 Childhood AD prevalence by race is 20.2% African American, 13% Asian, 12.1% White, 10% Hispanic, and 13% Native American.14,15 The annual financial impact of AD according to the National Eczema Association [NEA]14 for treating AD was $314 million.14

AD is caused by a complex cascade of physiological and non-physiological mechanisms that involve environmental, genetic,