A randomized controlled trial in children with eczema: nurse practitioner vs. dermatologist
Authors: M.L.A. Schuttelaar, K.M. Vermeulen, N. Drukker, P.J. Coenraads
Journal: British Journal of Dermatology (2009)

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 11·6 [SD 8·1; 95% confidence interval (CI) 9·0–14·2] at the baseline to 5·6 (SD 3·9; 95% CI 4·3–7·0) at 12 months with a mean change from the baseline of −6·5 (SD 6·6; 95% CI −14·2 to −8·9; P < 0·001). The mean IDQOL in the nurse practitioner group improved significantly from 10·7 (SD 4·9; 95% CI 9·1–12·3) at baseline to 5·7 (SD 5·4; 95% CI 4·0–7·5) at 12 months with a mean change from the baseline of −4·9 (SD 5·5; 95% CI −6·8 to −3·0; P < 0·001). The between-groups difference was (−)1·7 (95% CI −4·6 to 1·2; P = 0·26). The mean CDLQI in the dermatologist group improved significantly from 12·1 (SD 6·3; 95% CI 9·9–14·2) at baseline to 5·6 (SD 4·2; 95% CI 4·2–7·1) at 12 months with a mean change from the baseline of −5·9 (SD 6·0; 95% CI −8·0 to −3·9; P < 0·001). The mean CDLQI in the nurse practitioner group improved significantly from 10·0 (SD 4·4; 95% CI 8·5–11·4) at the baseline to 4·9 (SD 3·5; 95% CI 3·7–6·1) at 12 months with a mean change from the baseline of −5·2 (SD 4·0; 95% CI −6·6 to −3·8; P < 0·001). The between-groups difference was (−)0·7 (95% CI −3·3 to 1·7; P = 0·55). 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.