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, 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 participants in the BATHE study. We used descriptive statistics to compare participants' characteristics, consultation and prescribing patterns. We explored associations with eczema severity [Patient-Oriented Eczema Measure (POEM)], age and sex using Poisson and linear regression models. RESULTS: Mean age 4.8 (SD 2.9) years and POEM 10.0 (SD 5.8). Over 12 months, 386 children had a median of 4.0 (interquartile range 2.0-7.0) 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 (SD 4.5) prescriptions (median total quantity 1500 g or mL) per child over 12 months, yet 32.2% (136/422) were not prescribed any. On average, children were prescribed 1.3 (SD 0.5) different emollient types, with cream being most common [74.3% (211/284) children, 59.8% (778/1300) prescriptions]. In total, 51.7% (218/422) were prescribed a topical corticosteroid (TCS) with a mean of 2.8 (SD 2.5) prescriptions (90 g or mL) per child over 12 months and a mean of 1.4 (SD 0.6) different TCS potency types [mild being the most common 71.6% (151/211) children, 54.2% (316/583) prescriptions]. The number of consultations, but not the quantity of emollients and TCS prescribed, was associated with 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.