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Management strategies for chronic rhinosinusitis: A qualitative study of GP and ENT specialist views of current practice in the UK

Management strategies for chronic rhinosinusitis: A qualitative study of GP and ENT specialist views of current practice in the UK
Management strategies for chronic rhinosinusitis: A qualitative study of GP and ENT specialist views of current practice in the UK
Objectives: To explore GP and ENT specialist perspectives of current treatment strategies for chronic rhinosinusitis (CRS) and care pathways through primary and secondary care.

Design: Semi-structured qualitative telephone interviews as part of the MACRO programme.

Setting: Primary care and secondary care ENT outpatient clinics in the UK

Participants: Twelve GPs and 9 ENT specialists consented to in-depth telephone interviews. Transcribed recordings were managed using NVivo software and analysed using inductive thematic analysis

Main outcome measures: Healthcare professional views of management options and care pathways for CRS.

Results: GPs describe themselves as confident in recognising CRS, with the exception of assessing nasal polyps. In contrast, specialists report common missed diagnoses (e.g. allergy; chronic headache) when patients are referred to ENT clinics, and attribute this to the limited ENT training of GPs. Steroid nasal sprays provide the foundation of treatment in primary care, although local prescribing restrictions can affect treatment choice and poor adherence is perceived to be the causes of inadequate symptom control. Symptom severity, poor response to medical treatment, and patient pressure drive referral, although there is uncertainty about optimal timing. Treatment decisions in secondary care are based on disease severity, polyp status, prior medical treatment and patient choice, but there is major uncertainty about the place of longer courses of antibiotics and the use of oral steroids. Surgery is regarded as an important treatment option for patients with severe symptoms or with nasal polyps, although timing of surgery remains unclear, and the uncertainty about net longer term benefits of surgery makes balancing of benefits and risks more difficult.

Conclusions: Clinicians are uncertain about best management of patients with CRS in both primary and secondary care and practice is varied. An integrated care pathway for CRS is needed to improve patient management and timely referral.
2044-6055
Vennik, Jane
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Eyles, Caroline
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Thomas, David
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Hopkins, Claire
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Blackshaw, Helen
89f97306-9bba-42b3-a09f-4574d08bd711
Schilder, Anne G.M.
4efe172e-cbc9-4d1b-b089-f293f5c626ef
Boardman, Jim
54dd3bce-3739-4d06-8d1e-df295fd33fff
Philpott, Carl
3b9f988c-a61e-4736-9b69-6697fb2cdc5b
Vennik, Jane
6ee78166-5a7a-433b-87fc-018771f20b19
Eyles, Caroline
f8518cbb-669f-4cf6-bacb-4a174e385483
Thomas, David
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Hopkins, Claire
8ed0a5e3-92a3-4988-9c2b-b0e51a8a044c
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Blackshaw, Helen
89f97306-9bba-42b3-a09f-4574d08bd711
Schilder, Anne G.M.
4efe172e-cbc9-4d1b-b089-f293f5c626ef
Boardman, Jim
54dd3bce-3739-4d06-8d1e-df295fd33fff
Philpott, Carl
3b9f988c-a61e-4736-9b69-6697fb2cdc5b

Vennik, Jane, Eyles, Caroline, Thomas, David, Hopkins, Claire, Little, Paul, Blackshaw, Helen, Schilder, Anne G.M., Boardman, Jim and Philpott, Carl (2018) Management strategies for chronic rhinosinusitis: A qualitative study of GP and ENT specialist views of current practice in the UK. BMJ Open, 8 (12), [e022643]. (doi:10.1136/bmjopen-2018-022643).

Record type: Article

Abstract

Objectives: To explore GP and ENT specialist perspectives of current treatment strategies for chronic rhinosinusitis (CRS) and care pathways through primary and secondary care.

Design: Semi-structured qualitative telephone interviews as part of the MACRO programme.

Setting: Primary care and secondary care ENT outpatient clinics in the UK

Participants: Twelve GPs and 9 ENT specialists consented to in-depth telephone interviews. Transcribed recordings were managed using NVivo software and analysed using inductive thematic analysis

Main outcome measures: Healthcare professional views of management options and care pathways for CRS.

Results: GPs describe themselves as confident in recognising CRS, with the exception of assessing nasal polyps. In contrast, specialists report common missed diagnoses (e.g. allergy; chronic headache) when patients are referred to ENT clinics, and attribute this to the limited ENT training of GPs. Steroid nasal sprays provide the foundation of treatment in primary care, although local prescribing restrictions can affect treatment choice and poor adherence is perceived to be the causes of inadequate symptom control. Symptom severity, poor response to medical treatment, and patient pressure drive referral, although there is uncertainty about optimal timing. Treatment decisions in secondary care are based on disease severity, polyp status, prior medical treatment and patient choice, but there is major uncertainty about the place of longer courses of antibiotics and the use of oral steroids. Surgery is regarded as an important treatment option for patients with severe symptoms or with nasal polyps, although timing of surgery remains unclear, and the uncertainty about net longer term benefits of surgery makes balancing of benefits and risks more difficult.

Conclusions: Clinicians are uncertain about best management of patients with CRS in both primary and secondary care and practice is varied. An integrated care pathway for CRS is needed to improve patient management and timely referral.

Text
MACRO Healthcare professional views REVISION 2 22-10-18 CLEAN - Accepted Manuscript
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More information

Accepted/In Press date: 25 October 2018
e-pub ahead of print date: 19 December 2018

Identifiers

Local EPrints ID: 426121
URI: http://eprints.soton.ac.uk/id/eprint/426121
ISSN: 2044-6055
PURE UUID: ed3f7c03-3e07-4c3f-9adb-ed6c46cec9e7
ORCID for Jane Vennik: ORCID iD orcid.org/0000-0003-4602-9805

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Date deposited: 14 Nov 2018 17:30
Last modified: 28 Apr 2022 04:47

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Contributors

Author: Jane Vennik ORCID iD
Author: Caroline Eyles
Author: David Thomas
Author: Claire Hopkins
Author: Paul Little
Author: Helen Blackshaw
Author: Anne G.M. Schilder
Author: Jim Boardman
Author: Carl Philpott

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