Process evaluation of an integrated, multidisciplinary intervention programme for hand eczema

BACKGROUND. Over the last decade, few randomized controlled trials of high methodological quality have been carried out to evaluate the effectiveness of interventions for patients with hand eczema. Little to no attention has been paid to the feasibility of these interventions. This process evaluation was carried out to gain insight in the barriers to and facilitators for implementation of an intervention for hand eczema. The aims of this process evaluation were to examine the feasibility and the satisfaction of the patients and the professionals with the integrated care programme, and the perceived barriers to and facilitators for the use of the programme.

Eligible for this study were patients with moderate to severe chronic hand eczema who completed the integrated care programme. This programme is an intervention provided by a multidisciplinary team, consisting of a dermatologist, a specialized nurse, and a clinical occupational physician. Data were collected from the patients and the healthcare professionals, by means of semistructured telephone interviews, questionnaires, and a patient tracking system. Implementation, satisfaction and expectations were investigated.

Ninety-three patients completed the integrated care programme. Compliance with the integrated care programme was good. The results indicate good satisfaction of both patients and healthcare professionals with the integrated care programme. However, with regard to the process and feasibility of the integrated care programme, there is room for improvement. The clinical occupational physician was only involved in a very limited number of cases, the protocol was not flexible, and the intervention period was too compact. Most of the perceived barriers in the present study are at the organizational level.

Satisfaction with the integrated care programme was high among both patients and healthcare professionals. The involvement of the clinical occupational physician in the treatment, when indicated, should be optimized. With the multidisciplinary approach and good communication as a basis for the programme, and a more flexible protocol to avoid unnecessary consultations by the healthcare professionals, integrated care could be a useful treatment from a process evaluation perspective.