Consultations, prescribed topical treatments and disease severity in children with eczema in primary care: analysis of electronic medical records in the BATHE study

Background
In countries with well-resourced primary care, most children with eczema are managed by their General Practitioner (GP) but we know little about how often they are seen or how they are treated.

Objectives
To describe patterns of consultations and prescribing by eczema severity for children with eczema.

Methods
Analysis of electronic medical record data from 422/483 participants in the BATHE study. We used descriptive statistics to compare participants characteristics, consultation and prescribing patterns. We explored associations with eczema severity (POEM), age and gender using Poisson and linear regression models.

Results
Mean (SD) age 4.8 (2.9) years and POEM 10.0 (5.8). Over 12 months, 386 children had a median (IQR) of 4.0 (2-7) consultations. Of 2049 encounters, 1421 (69.4%) were for an eczema flare. Emollients were the most commonly prescribed item, with a mean of 4.6 prescriptions (507.9 g/ml) per child, yet 32.0% were not prescribed any. On average, children were prescribed 1.3 different emollient-types, with cream being most common (79.5% children, 66.5% prescriptions). 51.4% were prescribed a topical corticosteroid (TCS) with a mean of 2.8 prescriptions (50.6 g) per child and a mean of 1.4 different TCS potency-types (mild being the most common 73.3% children, 56.7% prescriptions). Number of consultations but not quantity of emollients and TCS prescribed were associated to age and eczema severity.

Conclusions
Children with eczema are seen frequently in primary care but are prescribed less emollient and TCS than might be appropriate for age and severity.