8 RESEARCH UPDATE
Eczema management trends , and community end-of-life care during Covid-19
We review investigations into patterns of eczema management in UK primary care , and the experiences of community nurses and GPs as they met an increased demand for end-oflife care during the pandemic
Patterns and trends in eczema management in primary care in England
Eczema is the most common infl ammatory skin condition in children worldwide , and one that often continues into adulthood . The condition can be incapacitating and patients of all ages can experience a psychological impact . Management is led by primary care , and attendance rates are high : 96 % of children with eczema have had a primary care attendance in the preceding year .
In their study 1 , de Lusignan and colleagues ( 2021 ) used a large primary care research database to assess healthcare use and treatment patterns among people in England with new onset of active eczema ( n = 411,931 ) between 2009 and 2018 .
Primary care consultation rates increased from 87.8 per 100 person-years to 112.0 per 100 person-years over that period , while specialist referral rates rose from 3.8 to 5.0 per 100 person-years . Primary care consultations were highest in children under two years of age , but referral rates were highest in over-50s .
Socioeconomic discrepancies were observed : specialist referral rates were lowest in people of lower socioeconomic status despite their higher rate of primary care consultations .
The study period saw slight alterations in prescribing practice . Prescription of emollients increased for those with active eczema from 48.5 % to 51.4 %, while there was a decrease in prescribing of topical corticosteroids from 57.3 % to 52 %. People of non-white ethnicities and lower socioeconomic status were less likely to be prescribed potent topical corticosteroids .
The authors said the disparities in eczema management warrant further study , in particular the lower rates of referral in those from more deprived backgrounds and the greater risk of progression to moderate and severe eczema in children of non-white ethnicity . The study ’ s main limitation was that inaccuracies in recording diagnosis dates mean onset for some patients may have occurred before the study period .
Reference 1 de Lusignan S et al . Patterns and trends in eczema management in UK primary care ( 2009 – 2018 ). Clin Exp Allergy 202 ; 51:483 – 494 . doi . org / 10.1111 / cea . 13783
Lucille Kelsall- Knight is a lecturer in children ’ s nursing at University of Birmingham School of Nursing
Community end-of-life care during the Covid-19 pandemic : views of GPs and community nurses
Primary care teams had to adapt service delivery models rapidly after the onset of Covid-19 , not least in response to a signifi cant increase in deaths in the community . In the fi rst months of the pandemic , deaths in care homes rose by 220 % and deaths at home by 77 %, while hospice deaths fell by 20 %. 1 This underlines the rise in workload burden on primary care .
Mitchell and colleagues ( 2021 ) conducted a study 2 to seek the views of GPs and community nurses providing end-of-life care during the fi rst wave , in order to inform future service planning and delivery . A questionnaire during September and October 2020 received 559 responses ( 387 community nurses , 156 GPs and 16 unspecifi ed roles ) from across the UK .
The results revealed GPs and community nurses both witnessed a signifi cant increase in the need to provide end-of-life care . Nurses took on greater responsibility in most care areas , including support to family members and symptom control ; GPs said they had seen an increase in advance care planning . Both groups found their working hours altered in response to rising demand for end-of-life care at home .
Changes to service delivery , such as the mandated move to virtual consultations , led to a disconnect between GPs and community nurses and wider teams . GPs reported that consulting remotely limited the end-of-life care they could offer , while community nurses perceived that services such as general practice and specialist palliative care had withdrawn , leaving them to manage rising demand . Both groups experienced a signifi cant emotional toll , with fears related to uncertainty and diminished colleague support .
The authors concluded primary care met an increased need for end-of-life care , at the cost of a considerable emotional impact on community nurses and GPs . They said this needed to be addressed , alongside the rebuilding of trust in teams . The study ’ s relatively low response rate from GPs was seen as a potential limitation .
References 1 Bone A et al . Changing patterns of mortality during the COVID-19 pandemic . Palliat Med 34 ( 9 ): 1193 – 1201 . bit . ly / 3cGj41S 2 Mitchell S et al . Community end-of-life care during the COVID-19 pandemic . BJGP Open 2021 ; 5 ( 4 ): BJGPO . 2021.0095 . bit . ly / 3cEeQrP nursinginpractice . com Winter 2021