Nurse-led clinics reduce severity of childhood atopic eczema: a review of the literature.
BACKGROUND
The increasing prevalence and impact of atopic eczema in children in Western countries such as Australia substantiate the need to evaluate the current management of this illness. It has been well documented that the most important aspects in the management of atopic eczema are to allow adequate time for education and demonstration of treatments. However, current models of healthcare funding restrict the opportunity for patient education during medical consultation times. The contribution of nursing to patient care through nurse-led clinics has significant potential in the management of many common chronic illnesses, although atopic eczema has received minimal attention by researchers to date.


OBJECTIVE
To discuss the current clinical management of atopic eczema, and to identify the evidence surrounding the benefits of nurse-led clinics in managing patients with chronic illnesses.


METHODS
Systematic searches were undertaken using the Cochrane Library, MedLine, PUBMed and CINAHL from 1995 to 2005. Manual searches of references of retrieved articles identified two additional key studies from 1990 and 1993 which were also included in the review.


RESULTS
In total, 22 relevant publications were identified. These included both primary research and descriptive studies that covered the medical management of eczema, patient education and improved patient outcomes. The evidence emerging from the literature indicates that the current management of eczema through doctor-led clinics could be improved, with doctors often lacking the time to offer sufficient patient education to manage chronic illnesses effectively. The literature supports the efficacy of nurse-led clinics in the management of chronic illnesses. The benefits of nurse-led clinics include increased patient satisfaction, longer consultations resulting in improved patient education and similar health outcomes when compared with care from a doctor. No studies were identified comparing nurse-led and doctor-led clinics in the management of eczema.


CONCLUSIONS
The most effective way to manage atopic eczema is to provide adequate time for education and demonstration of treatments, which the literature suggests can be achieved through nurse-led clinics. The literature review supports an investigation researching the outcomes of a nurse-led clinic on reducing the severity of eczema in children.
Moore
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E
Dermatology Department, The Royal Children's Hospital, Melbourne, Flemington Road, Parkville, Victoria, Australia. liz.moore@rch.org.au
Williams
A
A
Manias
E
E
Varigos
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G
D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000458:organization & administration / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003876:Dermatitis, Atopic / Q000451:nursing*; D003880:Dermatology / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D024802:Nurse's Role; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011787:Quality of Health Care