Eczema is a common distressing long-term skin condition, affecting one in five children and one in 10 adults in the UK. The majority of patients with eczema are treated in primary care and self-manage, so it is imperative that treatment plans can be systematically developed and address patient needs.
Dermatology is not represented in NHS outcome frameworks so, unlike asthma or diabetes, the majority of people with eczema in primary care receive limited structured management or support programmes. In primary care, practice nurses and nurse practitioners are experts in chronic-disease management, but people with skin conditions could really benefit from these skills being adapted to long-term dermatological conditions, such as eczema.
The self-care agenda states that people should be empowered to look after themselves where possible, and to take personal responsibility to manage their long-term conditions and improve their health. Eczema is included in this agenda as a condition that could be self-managed.
However, self-care requires shared decision-making between the patient and health professional. In any chronic disease, self-management plans should be individualised, and the consultations are often key to ensuring positive outcomes. Patients will generally feel more supported if they are listened to and treated as individuals, so using a clinical tool can be a valuable asset for promoting personalised and holistic consultations to ensure patient-centred care.
There are several tools in dermatology regularly used in secondary care dermatology, but a lack of both time and dermatology knowledge may be a limitation to using them effectively in primary care. The TalkingEczema tool, developed and tested by a panel of dermatology specialists in primary and secondary care, is unique, as it focuses on both the physical and psychological effects of eczema.
The tool can be used within the time constraints of a typical consultation to help focus the conversation on the patient’s needs. The tool gives health professionals a snapshot of how a patient is coping with eczema at that time, including motivation for self-management. These results can be plotted on a quadrant chart to identify typical patient traits. This is a cornerstone of chronic disease management.
Personalised questionnaires are enormously valuable in enabling the nurse to focus on the patient’s individual needs. However, questioning may reveal that the patient has not been using emollients as directed, owing to a perceived fear of side effects. These details may not be picked up in a normal consultation, and this is where the tool can be used to provide a deeper understanding of the patient’s regime and identify where improvements can be made. The skin-care plan can then be tailored to achieve optimal self-management.
Identifying where the patient can and should improve their management of eczema can be life-changing, as the nurse can empower the patient to take back control of their skin.
Julie Van Onselen is an independent dermatology nurse
The full-version of this article was first published in issue 20 of British Journal of Nursing