Anna B Fishbein1, Noor Hamideh2, Jennifer Lor2, Sharon Zhao2, Lacey Kruse3, Maryann Mason4, Adolfo Ariza4, Liliana Bolanos4, Jonathan Necheles5, Bennett Kaye5. 1. Division of Pediatric Allergy & Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, IL. Electronic address: afishbein@luriechildrens.org. 2. Division of Pediatric Allergy & Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, IL. 3. Division of Pediatric Dermatology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, IL. 4. Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL. 5. Children's Healthcare Associates, Chicago, IL; Community-Based Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, IL.
Abstract
OBJECTIVES: To characterize primary care providers' (PCPs) practice patterns for atopic dermatitis (AD) in children <2 years old and determine the need for AD guidelines for PCPs focused on this age group. STUDY DESIGN: This is a mixed-methods study consisting of a survey and a retrospective medical record review of PCP practices in the Chicago metropolitan area. The survey was analyzed using both quantitative and qualitative methods. RESULTS: In the survey (n = 52 respondents), PCPs reported management of AD is different in children <2 years compared with older children (88%). They were more likely to refer to a specialist (65%) and less likely to use high-potency topical corticosteroids (64%). In the chart review, PCP visits for children 2-5 years old (n = 50 914) vs those <2 years old (n = 71 913) for AD, older children had medium- and high-potency topical corticosteroids prescribed more frequently than younger children (0.66% vs 0.37%, P < .01 and .15% vs 0.05%, P < .01, respectively). In the subset of children <2 years of age who also were evaluated by a specialist (n = 109), medium- and high-potency topical corticosteroids were prescribed disproportionately at visits to providers in dermatology (57%) vs allergy (30%) vs pediatrics (15%) (P < .01). PCPs suggested that guidelines for this age group should include recommendations for preferred corticosteroids (39%), allergy management (35%), referral criteria (22%), and assessment of disease severity (11%). CONCLUSIONS: PCP management of AD in children <2 years is different from older children, with possible underuse of medium/high-potency topical corticosteroids. Clear guidelines for this age group are needed.
OBJECTIVES: To characterize primary care providers' (PCPs) practice patterns for atopic dermatitis (AD) in children <2 years old and determine the need for AD guidelines for PCPs focused on this age group. STUDY DESIGN: This is a mixed-methods study consisting of a survey and a retrospective medical record review of PCP practices in the Chicago metropolitan area. The survey was analyzed using both quantitative and qualitative methods. RESULTS: In the survey (n = 52 respondents), PCPs reported management of AD is different in children <2 years compared with older children (88%). They were more likely to refer to a specialist (65%) and less likely to use high-potency topical corticosteroids (64%). In the chart review, PCP visits for children 2-5 years old (n = 50 914) vs those <2 years old (n = 71 913) for AD, older children had medium- and high-potency topical corticosteroids prescribed more frequently than younger children (0.66% vs 0.37%, P < .01 and .15% vs 0.05%, P < .01, respectively). In the subset of children <2 years of age who also were evaluated by a specialist (n = 109), medium- and high-potency topical corticosteroids were prescribed disproportionately at visits to providers in dermatology (57%) vs allergy (30%) vs pediatrics (15%) (P < .01). PCPs suggested that guidelines for this age group should include recommendations for preferred corticosteroids (39%), allergy management (35%), referral criteria (22%), and assessment of disease severity (11%). CONCLUSIONS: PCP management of AD in children <2 years is different from older children, with possible underuse of medium/high-potency topical corticosteroids. Clear guidelines for this age group are needed.
Authors: Cathrine Helene Mohn; Hege S Blix; Anja Maria Brænd; Per Nafstad; Ståle Nygard; Jon Anders Halvorsen Journal: Dermatol Ther (Heidelb) Date: 2022-06-28
Authors: Thomas A Luger; Adelaide A Hebert; Andrea L Zaenglein; Jonathan I Silverberg; Huaming Tan; William C Ports; Michael A Zielinski Journal: Paediatr Drugs Date: 2022-03-16 Impact factor: 3.022