Referral Pathways for Children with Atopic Diseases in Denmark
DOI:
https://doi.org/10.2340/actadv.v104.34961Keywords:
Allergic rhinitis, Asthma, Atopic dermatitis, Disease management, Food hypersensitivity, ReferralAbstract
Atopic diseases such as atopic dermatitis, food allergy, allergic rhinoconjunctivitis, and/or asthma are common. In Denmark, however, there are multiple referral pathways for these diseases in the healthcare system and they are poorly understood. To describe how children with atopic diseases navigate their way through the Danish healthcare system, a questionnaire was distributed to children aged ≤ 17 years, who were being treated for atopic diseases between August 2020 and June 2021, either by a practising specialist or a hospital department, in the Capital Region of Denmark. A total of 279 children completed the questionnaire and most were referred to a specialist or to a hospital by their general practitioner. No “common track” to hospital existed for patients with ≥ 3 atopic diseases. These patients were more often referred to a hospital compared with children with 2 atopic diseases or fewer (odds ratio [OR] 3.79; 95% CI 2.07–7.24). The primary determinants for hospital treatment were food allergy (OR 4.69; 95% CI 2.07–10.61) and asthma (OR 2.58; 95% CI 1.18–5.63). In conclusion, children with multiple atopic diseases were more likely to be referred to hospital departments than to practising specialists, mainly due to food allergies.
Downloads
References
Pawankar R, Canonica GW, Holgate ST, Lockey RF, Blaiss MS. Chapter 2 The burden of allergic diseases. In: World Allergy Organization (WAO) White Book on Allergy. Update 2013: 2013: p. 27-72.
Henriksen L, Simonsen J, Haerskjold A, Linder M, Kieler H, Thomsen SF, et al. Incidence rates of atopic dermatitis, asthma, and allergic rhinoconjunctivitis in Danish and Swedish children. J Allergy Clin Immunol 2015; 136: 360-366.e362.
https://doi.org/10.1016/j.jaci.2015.02.003 DOI: https://doi.org/10.1016/j.jaci.2015.02.003
Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet 2006; 368: 733-743.
https://doi.org/10.1016/S0140-6736(06)69283-0 DOI: https://doi.org/10.1016/S0140-6736(06)69283-0
Weidinger S, Novak N. Atopic dermatitis. Lancet 2016; 387: 1109-1122.
https://doi.org/10.1016/S0140-6736(15)00149-X DOI: https://doi.org/10.1016/S0140-6736(15)00149-X
Belgrave DC, Granell R, Simpson A, Guiver J, Bishop C, Buchan I, et al. Developmental profiles of eczema, wheeze, and rhinitis: two population-based birth cohort studies. PLoS Med 2014; 11: e1001748.
https://doi.org/10.1371/journal.pmed.1001748 DOI: https://doi.org/10.1371/journal.pmed.1001748
Kilanowski A, Thiering E, Wang G, Kumar A, Kress S, Flexeder C, et al. Allergic disease trajectories up to adolescence: characteristics, early-life, and genetic determinants. Allergy 2023; 78: 836-850.
https://doi.org/10.1111/all.15511 DOI: https://doi.org/10.1111/all.15511
Egeberg A, Thyssen JP, Wu JJ, Pierce E, Terres JAR. Treatment patterns in Danish patients with atopic dermatitis before and after hospital referral. Dermatol Ther (Heidelb) 2021; 11: 499-512.
https://doi.org/10.1007/s13555-021-00491-2 DOI: https://doi.org/10.1007/s13555-021-00491-2
Sundhedsstyrelsen [Danish National Health Authority]. Status på allergi-området. Rapportering til Sundheds- og Ældreministeriet [Overview of the allergy area. Reporting to the Health and Senior Citizen Ministry]; 2017: p. 1-92.
Vestergaard C, Thyssen JP, Barbarot S, Paul C, Ring J, Wollenberg A. Quality of care in atopic dermatitis: a position statement by the European Task Force on Atopic Dermatitis (ETFAD). J Eur Acad Dermatol Venereol 2020; 34: e136-e138.
https://doi.org/10.1111/jdv.16092 DOI: https://doi.org/10.1111/jdv.16092
Wells R, McKay C, Makwana N, Vyas D, Vaughan S, Christopher A, et al. National survey of United Kingdom paediatric allergy services. Clin Exp Allergy 2022; 52: 1276-1290.
https://doi.org/10.1111/cea.14198 DOI: https://doi.org/10.1111/cea.14198
Yoo B, Park Y, Park K, Kim H. A 9-year trend in the prevalence of allergic disease based on national health insurance data. J Prev Med Public Health 2015; 48: 301-309.
https://doi.org/10.3961/jpmph.15.011 DOI: https://doi.org/10.3961/jpmph.15.011
Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019; 95: 103208.
https://doi.org/10.1016/j.jbi.2019.103208 DOI: https://doi.org/10.1016/j.jbi.2019.103208
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377-381.
https://doi.org/10.1016/j.jbi.2008.08.010 DOI: https://doi.org/10.1016/j.jbi.2008.08.010
von Kobyletzki L, Ballardini N, Henrohn D, Neary MP, Ortsater G, Geale K, et al. Care pathways in atopic dermatitis: a retrospective population-based cohort study. J Eur Acad Dermatol Venereol 2022; 36: 1456-1466.
https://doi.org/10.1111/jdv.18185 DOI: https://doi.org/10.1111/jdv.18185
Johansson EK, Brenneche A, Trangbaek D, Stelmaszuk MN, Freilich J, Anderson CD. Treatment patterns among patients with atopic dermatitis in secondary care: a national, observational, non-interventional, retrospective study in Sweden. Acta Derm Venereol 2022; 102: adv00774.
https://doi.org/10.2340/actadv.v102.1986 DOI: https://doi.org/10.2340/actadv.v102.1986
Ali Z, Ulrik CS, Egeberg A, Thyssen JP, Thomsen SF. Association of childhood atopic dermatitis with a higher risk of health care utilization and drug use for asthma: a nationwide cohort study. Dermatitis 2022; 33: 257-263.
https://doi.org/10.1097/DER.0000000000000724 DOI: https://doi.org/10.1097/DER.0000000000000724
Ali Z, Egeberg A, Thyssen JP, Ulrik CS, Thomsen SF. Adults with concomitant atopic dermatitis and asthma have more frequent urgent healthcare utilization and less frequent scheduled follow-up visits than adults with atopic dermatitis or asthma only: a nationwide cohort study. J Eur Acad Dermatol Venereol 2022; 36: 2406-2413.
https://doi.org/10.1111/jdv.18415 DOI: https://doi.org/10.1111/jdv.18415
Berni Canani R, Caffarelli C, Calvani M, Martelli A, Carucci L, Cozzolino T, et al. Diagnostic therapeutic care pathway for pediatric food allergies and intolerances in Italy: a joint position paper by the Italian Society for Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and the Italian Society for Pediatric Allergy and Immunology (SIAIP). Ital J Pediatr 2022; 48: 87.
https://doi.org/10.1186/s13052-022-01277-8 DOI: https://doi.org/10.1186/s13052-022-01277-8
Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy 2014; 69: 1008-1025.
https://doi.org/10.1111/all.12429 DOI: https://doi.org/10.1111/all.12429
Denton E, Lee J, Tay T, Radhakrishna N, Hore-Lacy F, Mackay A, et al. Systematic assessment for difficult and severe asthma improves outcomes and halves oral corticosteroid burden independent of monoclonal biologic use. J Allergy Clin Immunol Pract 2020; 8: 1616-1624.
https://doi.org/10.1016/j.jaip.2019.12.037 DOI: https://doi.org/10.1016/j.jaip.2019.12.037
Hansen S, von Bulow A, Sandin P, Ernstsson O, Janson C, Lehtimaki L, et al. Prevalence and management of severe asthma in the Nordic countries: findings from the NORDSTAR cohort. ERJ Open Res 2023; 9: 00687-2022.
https://doi.org/10.1183/23120541.00687-2022 DOI: https://doi.org/10.1183/23120541.00687-2022
Agache I, Beltran J, Akdis C, Akdis M, Canelo-Aybar C, Canonica GW, et al. Efficacy and safety of treatment with biologicals (benralizumab, dupilumab, mepolizumab, omalizumab and reslizumab) for severe eosinophilic asthma. A systematic review for the EAACI Guidelines: recommendations on the use of biologicals in severe asthma. Allergy 2020; 75: 1023-1042.
https://doi.org/10.1111/all.14221 DOI: https://doi.org/10.1111/all.14221
Paternoster L, Savenije OEM, Heron J, Evans DM, Vonk JM, Brunekreef B, et al. Identification of atopic dermatitis subgroups in children from 2 longitudinal birth cohorts. J Allergy Clin Immunol 2018; 141: 964-971.
https://doi.org/10.1016/j.jaci.2017.09.044 DOI: https://doi.org/10.1016/j.jaci.2017.09.044
Conrad LA, Cabana MD, Rastogi D. Defining pediatric asthma: phenotypes to endotypes and beyond. Pediatr Res 2021; 90: 45-51.
https://doi.org/10.1038/s41390-020-01231-6 DOI: https://doi.org/10.1038/s41390-020-01231-6
Thyssen JP, Corn G, Wohlfahrt J, Melbye M, Bager P. Retrospective markers of paediatric atopic dermatitis persistence after hospital diagnosis: a nationwide cohort study. Clin Exp Allergy 2019; 49: 1455-1463.
https://doi.org/10.1111/cea.13487 DOI: https://doi.org/10.1111/cea.13487
Sundhedsstyrelsen [Danish National Health Authority]. 3 Indhold i forløbsprogrammer [3 Content in Disease Management Programs]. In: Forløbsprogrammer for kronisk sygdom - den generiske model [Disease Management Programs for chronic disease - the generic model]; 2012: p. 9-23.
Kristensen MAT, Due TD, Holge-Hazelton B, Guassora AD, Waldorff FB. 'More constricting than inspiring': GPs find chronic care programmes of limited clinical utility. A qualitative study. BJGP Open 2018; 2: bjgpopen18X101591.
https://doi.org/10.3399/bjgpopen18X101591 DOI: https://doi.org/10.3399/bjgpopen18X101591
Bousquet J, Schunemann HJ, Togias A, Bachert C, Erhola M, Hellings PW, et al. Next-generation Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines for allergic rhinitis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and real-world evidence. J Allergy Clin Immunol 2020; 145: 70-80 e73.
Maleki-Yazdi K, Zhao I, Chu D. Values and preferences of patients and caregivers regarding treatment of atopic dermatitis: a systematic review. Ann Allerg Asthma Im 2022; 129: S74-S75.
https://doi.org/10.1016/j.anai.2022.08.717 DOI: https://doi.org/10.1016/j.anai.2022.08.717
Additional Files
Published
How to Cite
License
Copyright (c) 2024 Gitte Færk, Malin Glindvad Ahlström, Viktoria Helt-Eggers Lura, Susanne Reventlow, Jeanne Duus Johansen, Jacob P. Thyssen, Kirsten Skamstrup Hansen, Lone Skov
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
