The child with atopic dermatitis/food allergy and his parents: from victum to expert in the multidisciplinary team

Atopic Dermatitis is a chronic skin disease, with relapses and remissions. The
prevalence of atopic dermatitis worldwide is estimated at 3-10% (guideline
Atopic Dermatitis 2007). Besides, 30 - 60% of children with Atopic Dermatitis
suffer from food allergy. Because of the food allergy, patients have to follow
diets to prevent (them from) severe and dangerous allergic reactions. Atopic
Dermatitis as well as food allergy have a great impact on quality of life of
the children and their families.
In the last two years, we have developed Group Medical Appointments (GMA*s) for
children and their parents. During a GMA, the child and his parents have a
regular individual appointment in a group, consisting of about 8 patients and
their parents, a dermatologist and a dermatology nurse.
The patients and the members of the multidisciplinary team may give their
reactions on the problem of one of the patients. Thereby, patients and
professionals can learn from each other and help each other. Patients will
become expert patients. The presence of different professionals during the GMA
will be beneficial to patients* knowledge and self management and will
stimulate the complinace to the therapy and the life style adjustmens for the
atopic dermatitis/foodallergy.
Themes during the GMA and individual visits are the same, namely: monitoring of
the severity of the eczema, medical treatment, carrying out the medical
treatment, coping with consequences of eczema in daily life of the children and
their families.
GMA*s were developed in the United States. The Dutch CBO introduced the GMA
concept in the Netherlands. At this moment GMA*s have been implemented in care
for adults and children with different kinds of diseases and experiences are
satisfactory both for caretakers as for caregivers. However, the effects of
GMA*s on patient outcomes are unknown.
We hypothesize that patients and their parents will become better expert
patients by attending GMA*s as compared to individual visits. The child and his
parent will sooner achieve adequate self management, a better quality of life
and a reduction of physical complaints.

The research question of the underlying study is: What are the effects of GMA*s
on children with atopic dermatitis/ food allergy and their parents as compared
with individual visits on:
- physical complaints
- self management
- quality of life

Prospective randomized controlled study

In the underlying study Group Medical Appointments (GMA) will be compared with
individual visits. About 6-8 patients and their parents, a dermatology nurse
and a dermatologist will attend the GMA. The programme of a GMA is comparable
to that in the individual visit. Themes during the GMA and individual visits
are: monitoring of the severity of the eczema, medical treatment, carrying out
the medical treatment, coping with consequences of eczema in daily life of the
children and their families.

The burden of the study consists of filling out the questionnaires, four times
during one year, about 30 minutes per time. Besides, a Group Medical Appintment
(GMA) takes 45 minutes more than an individual visit. We expect a beneficial
effect of attending the GMA*s: adequate self management, a better quality of
life and a reduction of physical complaints. Ther will be no extra invasive
interventions. There are no risks in participating in the study.