A randomized controlled trial in children with eczema: nurse practitioner vs. dermatologist

Abstract

P>Background We hypothesized that a nurse practitioner would improve the quality of life of a child with eczema more than a dermatologist because of a structured intervention and more consultation time. Objectives To compare the level of care by nurse practitioners with that by dermatologists in children with eczema. Methods New referrals aged < 16 years with a diagnosis of eczema were recruited. In a randomized, parallel-group study with a follow-up period of 1 year, 160 participants were randomized either to conventional care from a dermatologist or to care from a nurse practitioner. The primary outcome measure was change in quality of life at 12 months, as assessed by the Infants' Dermatitis Quality of Life Index (IDQOL) for children aged < 4 years, and by the illustrated version of the Children's Dermatology Life Quality Index (CDLQI) for children aged 4-16 years. Secondary outcomes were changes in IDQOL and CDLQI at 4 and 8 months, family impact of childhood atopic dermatitis (Dermatitis Family Impact Questionnaire, DFI), eczema severity (objective SCORAD) and patient satisfaction (Client Satisfaction Questionnaire-8, CSQ-8) at 4, 8 and 12 months. Results The mean IDQOL in the dermatologist group improved significantly from 11 center dot 6 [SD 8 center dot 1; 95% confidence interval (CI) 9 center dot 0-14 center dot 2] at the baseline to 5 center dot 6 (SD 3 center dot 9; 95% CI 4 center dot 3-7 center dot 0) at 12 months with a mean change from the baseline of -6 center dot 5 (SD 6 center dot 6; 95% CI -14 center dot 2 to -8 center dot 9; P < 0 center dot 001). The mean IDQOL in the nurse practitioner group improved significantly from 10 center dot 7 (SD 4 center dot 9; 95% CI 9 center dot 1-12 center dot 3) at baseline to 5 center dot 7 (SD 5 center dot 4; 95% CI 4 center dot 0-7 center dot 5) at 12 months with a mean change from the baseline of -4 center dot 9 (SD 5 center dot 5; 95% CI -6 center dot 8 to -3 center dot 0; P < 0 center dot 001). The between-groups difference was (-)1 center dot 7 (95% CI -4 center dot 6 to 1 center dot 2; P = 0 center dot 26). The mean CDLQI in the dermatologist group improved significantly from 12 center dot 1 (SD 6 center dot 3; 95% CI 9 center dot 9-14 center dot 2) at baseline to 5 center dot 6 (SD 4 center dot 2; 95% CI 4 center dot 2-7 center dot 1) at 12 months with a mean change from the baseline of -5 center dot 9 (SD 6 center dot 0; 95% CI -8 center dot 0 to -3 center dot 9; P < 0 center dot 001). The mean CDLQI in the nurse practitioner group improved significantly from 10 center dot 0 (SD 4 center dot 4; 95% CI 8 center dot 5-11 center dot 4) at the baseline to 4 center dot 9 (SD 3 center dot 5; 95% CI 3 center dot 7-6 center dot 1) at 12 months with a mean change from the baseline of -5 center dot 2 (SD 4 center dot 0; 95% CI -6 center dot 6 to -3 center dot 8; P < 0 center dot 001). The between-groups difference was (-)0 center dot 7 (95% CI -3 center dot 3 to 1 center dot 7; P = 0 center dot 55). The between-groups comparison was not significant for the IDQOL and the CDLQI at baseline or 4, 8 and 12 months. Both treatment groups showed significant improvement in DFI and objective SCORAD at 12 months. The between-groups comparison was not significant at baseline or 4, 8 and 12 months. Significantly higher satisfaction levels were observed at 4, 8 and 12 months in the nurse practitioner group. Conclusions The level of care provided by a nurse practitioner in terms of the improvement in the eczema severity and the quality of life outcomes was comparable with that provided by a dermatologist. In addition, the parents were more satisfied with the care that was provided by a nurse practitioner