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Ear, nose and throat/otolaryngology
Research
Chronic rhinosinusitis: a qualitative study of patient views and experiences of current management in primary and secondary care
  1. Jane Vennik1,
  2. Caroline Eyles1,
  3. Mike Thomas1,
  4. Claire Hopkins2,
  5. Paul Little1,
  6. Helen Blackshaw3,
  7. Anne Schilder3,
  8. Imogen Savage4,
  9. Carl M Philpott5,6
  1. 1 Primary Care and Population Sciences, University of Southamption, Southampton, UK
  2. 2 ENT, Guys Hospital, London, UK
  3. 3 EvidENT, University College London Ear Institute, London, UK
  4. 4 EvidENT Patient Panel, University College London Ear Institute, London, UK
  5. 5 Norwich Medical School, University of East Anglia, Norwich, UK
  6. 6 Ear, Nose and Throat, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
  1. Correspondence to Dr Jane Vennik; j.vennik{at}soton.ac.uk

Abstract

Objectives To explore patient views and perspectives of current management of chronic rhinosinusitis (CRS) in primary and secondary care.

Design Semistructured qualitative telephone interviews as part of the MACRO programme (Defining best Management for Adults with Chronic RhinOsinusitis).

Setting Primary care and secondary care ear, nose and throat outpatient clinics in the UK.

Participants Twenty-five patients consented to in-depth telephone interviews. Transcribed recordings were managed using NVivo software and analysed using inductive thematic analysis.

Results CRS has a significant impact on patients’ quality of life, affecting their ability to work effectively, their social interactions and daily living. Patients seek help when symptoms become unmanageable, but can become frustrated with the primary care system with difficulties obtaining an appointment, and lack of continuity of care. Patients perceive that general practitioners can be dismissive of CRS symptoms, and patients often prioritise other concerns when they consult. Health system barriers and poor communication can result in delays in accessing appropriate treatment and referral. Adherence to intranasal steroids is a problem and patients are uncertain about correct technique. Nasal irrigation can be time-consuming and difficult for patients to use. Secondary care consultations can appear rushed, and patients would like specialists to take a more ‘holistic’ approach to their management. Surgery is often considered a temporary solution, appropriate when medical options have been explored.

Conclusions Patients are frustrated with the management of their CRS, and poor communication can result in delays in receiving appropriate treatment and timely referral. Patients seek better understanding of their condition and guidance to support treatments decisions in light of uncertainties around the different medical and surgical options. Better coordinated care between general practice and specialist settings and consistency of advice has the potential to increase patient satisfaction and improve outcomes.

  • qualitative research
  • quality of life
  • primary care
  • patient views
  • sinusitis

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/.

https://doi.org/10.1136/bmjopen-2018-022644

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    Footnotes

    • Contributors The protocol was developed by CE, MT, CMP, CH, AS, PL and HB. IS helped to pilot the interview guide. JV led the data collection and analysis, with academic contributions from CE, MT, CMP and CH. IS provided a patient perspective during analysis and interpretation. JV drafted the manuscript and coordinated the revisions from the authors. All authors read and approved the final manuscripts.

    • 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.

    • 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 (Reference number: 16/NI/0197).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.

    • Patient consent for publication Not required.

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