Developing and Piloting a Brief Intervention to Support Eczema Self-management in Community Pharmacy.

Background The Eczema Care Online toolkit (ECO) has been shown to offer clinical benefit in two randomised controlled trials. Access to the toolkit led to improved eczema symptoms for young people (mean difference in Patient Orientated Eczema Measure −1.9 (95% Confidence Interval (95%CI) −3.0 to −0.8; P<0.001)) and for families with young children (−1.5 (95%CI −2.5 to −0.6; P=0.002)). Improvement was maintained at 52 weeks. The toolkit was shown to be cost-effective and acceptable to stakeholders. Research as part of ECO identified community pharmacy as an avenue for future implementation. Other research has confirmed this potential – skin conditions represent a significant aspect of community pharmacy work, with eczema a common topic for customer enquiry. However, our prior work with pharmacy staff indicates that they require further training and dedicated resources to confidently engage with the self-management of skin conditions. Aim To build upon ECO by developing and piloting a Community Pharmacy Brief Intervention (a staff instigated "eczema conversation") that will support eczema self-management. The brief intervention will include a link to ECO (www.eczemacareonline.org.uk). We will also develop training and resources for pharmacy staff that will help them to have these conversations. Methods In Phase 1 we will use the Person Based Approach to distil aspects of ECO into a resource that is usable in community pharmacy. This will involve a series of workshops with pharmacists, pharmacy staff, and members of the public. In these workshops we will consider the challenges that pharmacy staff experience in dealing with eczema enquiries; we will review ECO resources to establish which are most useful to pharmacy staff; and, we finalise the mode of delivery for a brief intervention. In the Phase Two we will pilot the brief intervention in six community pharmacies. These pharmacies will reflect a range of different socio-demographic contexts: we will recruit pharmacies in more deprived areas (using IMD scores), by number of items dispensed (greater or fewer), and by location (e.g. in rural areas, city centres, retail parks, small towns, etc.). In each pharmacy over a three-month period, we will record the number of staff trained to use the brief intervention, the number of times it is delivered, the resources provided, and track associated hits to the ECO website. We will also interview pharmacy staff to understand the impact that it has upon the pharmacy, upon individual roles and job satisfaction, customer reactions, and barriers to delivering the brief intervention. Customers who receive the intervention will have an opportunity to complete a short online feedback survey. Impact Effective mobilisation of ECO via a Community Pharmacy Brief Intervention means that more people will benefit from this evidence-based self-management toolkit. It also means that individuals living in areas where other healthcare is lacking might benefit - 99% of people living in a deprived area are within a 20-minute walk of a pharmacy. Demonstrating the potential of a Community Pharmacy Brief Intervention for eczema self-management could inform its adoption in broader, national initiative such as "Pharmacy First" or the "New Medicine s Service".