Parents receive information about AD and its treatment mainly from prescribing dermatologists, general practitioners, and pediatricians. They have an important role in providing parents with correct information and supporting them with medication use. Previously, Bos et al. showed corticophobia among healthcare providers involved in treatment of pediatric patients with AD. Their study showed scores of 31% for pediatricians and public health physicians and a score of 39% for general practitioners. In line with these previous findings, we showed corticophobia among pharmacists and pharmacy technicians. This corticophobia can affect the perspective of parents towards medication use.
The total TOPICOP score for pharmacy staff in our study was 33%. Lambrechts et al. described similar levels of corticophobia among pharmacists and suggested re-educating healthcare providers, as counseling should not be influenced by their own prejudices. Interventions targeted at the sources of TCS phobia and focusing on patient education and counseling seem to be useful. Lee and coworkers showed that a simple educational intervention, a 10–15 min patient counseling session about TCS by dermatologists, improved patient compliance. In addition, other training pharmacy programs have been shown to be effective in improving pharmacy staff’s knowledge and skills with a positive impact on patient outcomes. Kang et al. showed that an increase in community pharmacists’ knowledge level about topical corticosteroids positively associated with the quality of practice.
To our knowledge, this is the first pharmacy intervention study focusing on the improvement of treatment in patients with AD. Strong points of our study are the relatively simple intervention strategy, which facilitates implementation in daily practice. We showed that with relatively limited time and effort, a clinically relevant improvement in pediatric AD care can be achieved. In addition, both pharmacy staff and parents were positive about the intervention. The developed tools were useful for pharmacy staff and parents value the attention and advice given by the pharmacy staff.
Our follow-up time was relatively short, so we only assessed the short-term effects of our educational intervention. For a sustainable effect, regular training or attention of pharmacy staff is necessary to maintain awareness around optimal treatment of atopic dermatitis. In addition, it is important to address this regularly during patient consultations.
We used online questionnaires for data collection. This is an efficient way of collecting data, as data are entered directly by participants in an online database and participants can fill out the questionnaire whenever and wherever they want to. A limitation might be the use of self-reported measurements, resulting in potential desirability bias. However, pharmacy staff did not get insight into the answers of parents and research staff did not attend the counseling sessions. Furthermore, attitudes towards medication (corticophobia) can only be measured using self-report. We used the TOPICOP questionnaire, which has shown success in different settings. However, there is no officially validated Dutch version of the questionnaire. We used it for comparison in groups and used the questionnaire provided by Bos et al. The mean score we found in our study was similar to the scores presented by Bos et al.
Another limitation is the relatively low response rate and high drop-out rate. 69 patients were part of the intervention, but for only 48 of them, we received follow-up data. We aimed to enroll about 20 patients per pharmacy, which we unfortunately did not reach. This is partly due to our inclusion criteria, “dispensing of a TCS in the past 6 months.” As the pharmacy information system does not include information about the indication for use, TCS could also be prescribed for other treatment purposes and not only AD. This is one reason for the loss of part of our selected patients. Furthermore, only half of the parents who filled out the baseline questionnaire and attended the counseling session responded to the follow-up questionnaire. This may be due to limited time of young (working) parents. Besides that, loss to follow-up is common in longitudinal study designs in which repeated actions of the participants are expected. It is also possible that parents who had concerns towards TCS were more interested in participation in the study. Thus, some degree of selection bias might have occurred. Furthermore, data were collected only during spring and summer, thus we could not take possible seasonality of symptoms into account. Some studies report peaks in AD symptoms during this period, whilst Kramer et al. reported that symptoms and seasonal influences depend on the individual. In their study, some children reported more severe symptoms in winter (temperature-based) whilst others experienced more severe symptoms in spring (allergy-induced). Environmental factors, such as swimming and high temperature during summer, might also influence the occurrence of symptoms during this season.
