Article Text
Abstract
Objectives To explore general practitioner (GP) and ears, nose and throat (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 (Defining best Management for Adults with Chronic Rhinosinusitis)
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 (eg, 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 long-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.
- qualitative research
- sinusitis
- gp views
- endoscopic sinus surgery
- ent specialist views
- patient care management
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Footnotes
Contributors The protocol was developed by CE, MT, CMP, CH, AS, PL and HB. JV led the data collection and analysis, with academic contributions from CE, MT, CMP and CH. JV drafted the manuscript and coordinated the revisions from all authors. All authors read and approved the final manuscripts. A patient contributor (JB) from the MACRO programme management group also provided input into the design of the study, and reviewed and commented on drafts of this manuscript.
Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research (PGfAR) Programme (Grant Reference Number RP-PG-0614-20011).
Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
Competing interests None declared.
Patient consent Not required.
Ethics approval The study was given ethical approval by the Health and Social Care Research Ethics Committee A (HSC REC A) on 22 September 2017 (16/NI/0197).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement There is no additional data available for sharing.
Linked Articles
- Ear, nose and throat/otolaryngology