Kw. Shum et al., The British Association of Dermatologists audit of atopic eczema management in secondary care. Phase 1: audit of service structure, BR J DERM, 141(3), 1999, pp. 430-437
This first comprehensive study of atopic eczema management describes an aud
it of service structure (phase 1), process (phase 2) and outcome (phase 3)
in the U.K. This paper describes the phase 1 results. Service structure was
audited by a single-page questionnaire containing 10 questions on outpatie
nt facilities, This was sent to the lead dermatologist at 187 dermatology c
entres throughout the U.K., and a final response rate of 98% was achieved,
Although the percentage of centres reporting the presence of recommended fa
cilities did not reach the 100% working standard for any one specific crite
rion, about half of the recommended items, such as provision of height and
weight measuring facilities, access to a dietician, patch testing and photo
chemotherapy was reported in over 90% of centres. Areas of service structur
e which were infrequently reported to be in place were issuing of new appoi
ntment letters asking patients to bring their treatment details to clinic (
52% of centres) and access to nurses with dermatology experience on paediat
ric wards (57% of centres), Some audit measures, e.g. access to counselling
services, showed wide regional variation (range 33-94% of centres), and th
ese variations could not be explained simply in terms of provision of speci
alists. Some of the elements of service structure, such as access to nurses
with dermatology experience on paediatric wards, map be difficult to chang
e in the short term because of funding and staffing constraints, but others
, such as provision of growth charts, are easy to change at little cost. Th
is preliminary audit serves as a framework for future audits of atopic ecze
ma management.