5. Interventions Flashcards
What interventions would you recommend to help the patient manage their allergies better.
Why do we need interventions?
Due to the effect allergies have on stress, anxiety, depression, worry and QoL, for both patients and family, their ability to cope adaptively and manage is often negatively impacted.
An intervention is anything designed to help change the way people think, feel and behave to improve their QoL.
A range of interventions can help patients and their families cope in order to have a better QoL eg
- educational interventions
- support groups, face to face or online
- individual or group CBT for patient/parent online or face to face
- mindfulness and acceptance and commitment therapy
Weber et al (2008)
Support Group for AD 1
Looked to evaluate the intensity of pruritus (intense skin itching) and the QoL in children with atopic dermatitis and their families after joining support groups.
32 patients and their relatives completed the questionnaires. Subjects were randomly assigned to intervention or control group and completed the Children’s Dermatology Life Quality Index (CDLQI) and Family Dermatitis Impact (FDI). Pruritus was evaluated by the Yosipovitch’s questionnaire for pruritus.
After intervention, pruritus intensity was similar, but the pattern of pruritus improved in the intervention group. Overall QoL improved significantly and, when specific domains were analysed, personal relationships and leisure showed marked enhancement. Scores failed to demonstrate differences in the QoL of patients’ relatives after treatment - patients had benefits with the attendance to support groups.
Pickett et al (2015)
Support group for AD 2
A systematic review assess the clinical effectiveness and cost-effectiveness of educational interventions to improve HRQoL in people with chronic inflammatory skin diseases.
Seven RCTs were included in the review of clinical effectiveness. Two RCTs focused on children with eczema and their carers. Five RCTs were in adults. Of these, two were of people with psoriasis, one was of people with acne and two were of people with a range of conditions.
Carers of children in one RCT of eczema showed improvement in HRQoL; however, in a RCT evaluating a website intervention there were no demonstrable effects on HRQoL compared.
There is uncertainty regarding whether educational interventions addressing issues that could improve HRQoL in people with chronic skin conditions are effective. Face-to-face group sessions by a multidisciplinary team may be most beneficial.
Interventions for FA
Interventions for FA have been shown to improve
- QoL for parents and children
- Psychological outcomes such as stress, anxiety, worry and depression
- Adaptive coping strategies for FA management
- Knowledge about FA
- Rates of allergic reactions
Le Boveidge et al (2008)
Face-to-face group support for parents of children with Food Allergy
61 children aged 5-7 and parents attended a half-a-day workshop to help increase parent-perceived competence in coping and decrease burden.
Parent and child group ran concurrently and pre, post and 4-8 week measures were taken via questionnaire.
Parent perceived competence in coping increased and burden decreased from the pre-workshop to the follow up.
Coulson and Knibb (2007)
Online support for adults with FA themselves or have a child with FA
32 females on an online support group participated, 60% had a FA and the rest had a close member of family with FA.
The advantages of an online support group was
+ accessibility
+ social support - opportunity to both give and receive it
+ able to discuss and develop adaptive cognitive and emotional coping strategies, particularly targetting feelings of isolation
- trust in the information provided, there was no certainty for allergen free recipes not causing a reaction
- absence of cues normally associated with social communication
- interaction with healthcare providers regarding use of online support groups and the internet for getting health related information
Darsow et al (2005)
Support groups, also called ‘eczema schools’, have been reported for many years as a new proposal for the guidance of AD patients and their families showing a significant improvement in the subjective and objective symptoms of the disease.
