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

Abstract

ObjectivesTo 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.DesignSemi-structured qualitative telephone interviews as part of the MACRO programme (Defining best Management for Adults with Chronic Rhinosinusitis)SettingPrimary care and secondary care ENT outpatient clinics in the UK.ParticipantsTwelve 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 measuresHealthcare professional views of management options and care pathways for CRS.ResultsGPs 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.ConclusionsClinicians 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.

Chronic rhinosinusitis: a qualitative study of patient views and experiences of current management in primary and secondary care

“…This paper reports a qualitative interview study exploring CRS patients’ views and experiences of living with CRS and aims to understand the treatment pathway from the patient perspective. Views and experiences of general practitioners (GPs) and ears, nose and throat (ENT) specialists are also explored as part of this work but presented elsewhere 9. This study is part of the wider National Institute of Health Research supported MACRO programme (Defining best Management for Adults with Chronic Rhinosinusitis)10 which aims to define best practice for treating and managing patients with CRS.…”

Expert panel process to optimise the design of a randomised controlled trial in chronic rhinosinusitis (the MACRO programme)

“…1 and 2) prior to the interview and asked their views and opinions about the barriers and facilitators to each design, with respect to treatment arms, timings of treatments, recruitment of patients and retention in the trial. Further details about recruitment and data collection are published elsewhere [6].…”

“…Qualitative and quantitative data were individually analysed in three separate analyses: health informatics (EW, SD, JC), health economics (CC, SM), and qualitative (JV, CE, MT). The methods and results of these individual analyses are presented independently elsewhere [6]. The expert panel convened in July 2017.…”

Expert panel process to optimise the design of a randomised controlled trial in chronic rhinosinusitis (the MACRO programme).

“…5 Farr Institute, University College London, London, UK. 6 London School of Hygiene and Tropical Medicine, London, UK. 7 Research Department of Primary Care and Population Health, University College London, London, UK.…”