Development and Evaluation of a Clinical Practice Guideline to Promote Evidence-Based Treatment of Childhood Atopic Dermatitis in Primary Care

Abstract

ABSTRACT Introduction and Rationale: Atopic Dermatitis (AD) is a common skin condition, characterized by markedly pruritic eczematous lesions, that most often presents in childhood. The majority of children diagnosed with AD will have mild disease and will first present with symptoms to a primary care provider (PCP), however approximately 85% of pediatricians only provide limited initial care followed by a referral to dermatology (Eichenfield et al., 2015). While there are specialty care based treatment guidelines for childhood AD, there are no guidelines available that specifically address primary care management of childhood AD. Purpose and Objective: The primary purpose of this DNP project is to develop an evidence-based clinical practice guideline (CPG) for pediatric PCPs. The secondary purpose is to develop a corresponding atopic dermatitis action plan (ADAP) to be used by children and parents. The objective is to equip PCPs to better manage children with AD in the primary care setting and to guide patients and parents in the importance of daily control measures and in the individualized treatment plan prescribed by the PCP. Methods: The Appraisal of Guidelines for Research & Evaluation II (AGREE II) framework and Social Cognitive Theory (SCT) serve as the theoretical frameworks for CPG and ADAP development. The American Academy of Pediatrics (AAP) process for evidence based policy setting is used as a model for key action statement development. Results: Evaluation of the CPG was completed using the AGREE II tool, a reliable and validated tool for evaluating CPGs. Five of the six domains evaluated, yielded combined scores of at least 90%, with one domain a combined score of 63%. The overall standard deviation was 0.58, indicating an overall low level of user discrepancy Additions and revisions were made based on the results of the AGREE II evaluation scores with specific emphasis on the lowest scoring domain. Conclusion: This DNP Project identified the need for a CPG specific to pediatric primary care. A CPG with accompanying ADAP was developed and evaluated using the AGREE II tool. The CPG was found to meet the recommended standards and recommended for use in pediatric primary care.