Written action plans to support the self-management of eczema: findings from an international review

Problem

Eczema is a common inflammatory condition which can affect 15-30% of children and 2-10% of adults1. Eczema can have a significant impact2 and can also lead onto other conditions which include asthma and allergic rhinitis. The management of eczema can be challenging and it is important for patients, parents, and caregivers to know how to look after their skin. Adherence to treatment in eczema is poor and therefore it is important that there are adequate resources made available which can be used to self-manage eczema. One way to support this is to give them a written action plan (WAP), which contains information about steps that can be taken which can help self-management of eczema.

Approach

Our aim is to map the written eczema plans that are available which can be used by patients, parents, and caregivers. We searched relevant databases (MEDLINE, Embase, COCHRANE) from inception to the latest available date at the time of the search for publications in any language using English search terms. In addition to this an email was sent out requesting any further resources relevant to the review via the UKDCTN (UK Dermatology Clinical Trials Network), SAPC (Society for Academic Primary Care) and ISAD (International Society of Atopic Dermatitis). We followed preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Our searches identified over 300 papers and these were independently reviewed by two different reviewers. We looked at a number of outcomes which included the length of the WAP, whether the WAP is visually appealing, how it was developed and whether it had been evaluated.

Findings

We found multiple written action plans, with many given by secondary care providers to help patients manage their condition at home. A significant number also contained information on how to get support and certain triggers that may lead to worsening eczema. However, only a small proportion of written action plans describe any theoretical underpinning which led to their design or evaluation of their acceptability or effectiveness. In addition only a few of the currently available WAPs contain a diary section for patients or caregivers to record their daily progress.

Consequences

While there are many eczema WAPs, it is apparent that there needs to be more research done which evaluates their perceived value and impact on treatment adherence and eczema control. WAPs need to be accessible and easy to use for both patients and caregivers and a standardised approach is likely to be helpful.