Appendix C. Detail on criteria for audit of the frequency of application of topical corticosteroids for atopic eczema

Appendix C. Detail on criteria for audit of the frequency of application of topical corticosteroids for atopic eczema

Possible objectives for an audit

An audit could be carried out to ensure the appropriateness of prescription of topical corticosteroids for atopic eczema.

Possible patients to be included in the audit

An audit could be carried out on all patients seen for atopic eczema in a reasonable period for audit, for example, 6 months, who are prescribed topical corticosteroids but not those topical agents that combine corticosteroids with other active agents (for example, antimicrobials or salicylic acid).

Measures that could be used as a basis for an audit

The measures that could be used in an audit of the prescription of topical corticosteroids for atopic eczema are shown in the table following.

Criterion

Standard

Exception

Definition of terms

1. Topical corticosteroids for atopic eczema are prescribed for application only once or twice daily

100% of people for whom topical corticosteroids for atopic eczema are prescribed

None

The diagnosis of atopic eczema is established by the person having an itchy skin condition in the past 12 months plus three or more of the following: history of flexural involvement (that is, affecting the bends of the elbow or behind the knees); history of a generally dry skin; personal history of other atopic disease (in children younger than 4 years, history of atopic disease in a first-degree relative may be included); visible flexural dermatitis as defined by a photographic protocol; and onset before the age of 2 years (not used in children younger than 4 years).

For a list of preparations of topical corticosteroids that are relevant for this measure,seeAppendix D.

2. If more than one alternative topical corticosteroid is considered clinically appropriate within a potency class, the drug with the lowest acquisition cost is prescribed

100% of people who are prescribed topical corticosteroids for atopic eczema

None

Clinicians will need to agree locally on how the lowest acquisition cost is determined for audit purposes, taking into account pack size and frequency of application. See Appendix D for a list of preparations by potency class.

Calculation of compliance

Compliance (%) with each measure described in the table above is calculated as follows.

Number of patients whose care is consistent with the criterion plus number of patients who meet any exception listed

x 100

Number of patients to whom the measure applies

Clinicians should review the findings of measurement, identify whether practice can be improved, agree on a plan to achieve any desired improvement and repeat the measurement of actual practice to confirm that the desired improvement is being achieved.