title: The effect of dermatology consultations in secondary care on treatment outcome and quality of life in new adult patients with atopic dermatitis.
abstract: BACKGROUND
  The prevalence of atopic dermatitis (AD) is increasing worldwide, and many patients present to secondary care in adult life. This is a significant contribution to the workload of all dermatology departments. There are no studies investigating the impact of a dermatology consultation within secondary care.
  
  
  OBJECTIVE
  To examine the effect of dermatology consultations in secondary care on treatment outcome and quality of life in new adult patients with AD.
  
  
  METHODS
  This prospective observational study recruited new adult patients with AD referred from primary care. Eczema severity was assessed using the SCORAD (Severity Scoring of AD) index and subjective good or poor clinical outcome. The Dermatology Life Quality Index (DLQI) was used to quantify the impact of AD on adult patients. Patients were assessed at initial consultation (T1), 6 weeks (T2) and 3 months (T3). Statistical analysis was performed using independent t-tests, repeated-measures analysis of variance, correlation coefficients and Bonferroni post hoc comparisons.
  
  
  RESULTS
  Sixty-three patients were recruited (37 women, 26 men) with a mean age of 34 years. Mean SCORAD at T1 was 48.2 and the majority (51%) had severe eczema (objective SCORAD>40). Mean SCORAD reduced by 52% from T1 to T2 (P<0.001) but there was no significant change in SCORAD from T2 to T3. A subjective good clinical outcome was validated by a decrease in SCORAD of >20 (P<0.001). Patients in the good clinical outcome group were significantly older than those in the poor clinical outcome group (38 vs. 27 years, P<0.05). The mean age at presentation of women was significantly younger than men (29 vs. 43 years, P<0.01). Women's mean SCORAD improved over all three visits, while men's mean SCORAD improved from T1 to T2 but worsened from T2 to T3 (P<0.001). The mean DLQI reduced over all three visits, from 9.5 at T1 to 8.8 at T2 and 7.0 at T3, and was significantly correlated with SCORAD at T1 and T2 (P<0.01). Patients accurately self-scored their eczema on a body map as shown by a significant correlation between these scores and SCORAD at T1 and T2 (P<0.001).
  
  
  CONCLUSIONS
  We have shown that within the first 3 months of referral to secondary care, new adult patients with AD have the greatest improvement in AD, measured by SCORAD, after their initial appointment. Quality of life, as measured by DLQI, continued to improve over all three visits.
authors.affiliation: Department of Dermatology, General Infirmary at Leeds, Institute of Psychological Sciences, University of Leeds LS1 3EX, UK. susannah.baron@ntlworld.com
authors.forename: S E
authors.initials: SE
authors.lastname: Baron
authors.forename: P K
authors.initials: PK
authors.lastname: Morris
authors.forename: L
authors.initials: L
authors.lastname: Dye
authors.forename: D
authors.initials: D
authors.lastname: Fielding
authors.forename: V
authors.initials: V
authors.lastname: Goulden
mesh_terms: D000293:Adolescent; D000328:Adult; D003876:Dermatitis, Atopic / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010352:Patient Dropouts; D011446:Prospective Studies; D011788:Quality of Life; D012017:Referral and Consultation; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome