Zhongguo quanke yixue (Mar 2023)
Allergic Rhinitis-related Knowledge, Diagnosis and Treatment among General Practitioners in Chaoyang District, Beijing
Abstract
Background Allergic rhinitis (AR) is a highly prevalent chronic non-communicable disease. The research on the understanding and treatment of AR in China is mainly in otorhinolaryngology specialists, but rarely in general practitioners (GPs) in primary care. And recommendations on the diagnosis and treatment of AR in primary care are also insufficient. Objective To explore the understanding of AR and diagnosis and treatment capacities related to AR in GPs in primary care. Methods By use of simple random sampling, 432 GPs from 21 community health service organizations in Beijing's Chaoyang District were chosen between August and September 2020. The questionnaire was combined with the Guidelines for the Diagnosis and Treatment of Allergic Rhinitis (Tianjin, 2015) (China 2015 AR Guidelines) and Allergic Rhinitis and Its Impact on Asthma (ARIA) Guidelines: 2010 Revision, and its 2016 annual revision, and refinement of the questionnaire after consultation with experts and pre-survey. The information obtained from the questionnaire included basic information about the subjects, understanding level, diagnostic and therapeutic behaviors, training, and support needs regarding AR, et al. Results The 383 (88.7%) of the 432 questionnaires were finally returned. Only 0.8% (3/383) of the GPs correctly responded to all of the questions on typical AR symptoms, diagnosis, treatment philosophies, first-line drug classes, and regimens suggested by guidelines. Guidelines for AR, including China 2015 AR Guidelines and ARIA Guidelines, were known to 32.4% (124/383) of the GPs, Web-based continuing education such as www.haoyisheng.com, www.dxy.cn and WeChat and related training. When treating each patient with a respiratory illness, the prevalence of GPs differentiating AR from others, providing recommendations on environmental control, suggesting nasal rinsing, recommending other treatments instead of immunotherapy, and referring the patient to the specialty department without any treatment, was 59.8% (229/383) , 37.1% (142/383) , 17.8% (68/383) , 49.4% (189/383) , and 13.1% (50/383) , respectively. In terms of pharmacological treatment, 17.5% (67/383) of GPs said their hospital offered all four classes of first-line AR medications. As for AR-related training, 75.7% (366/383) of the GPs reported not having taken any AR-related training in 2019; and 91.7% (266/290) needed the training. And 95.6% (290/383) of the GPs said AR should be handled standardizedly in the community. A multivariate stepwise regression Logistic analysis revealed that when encountering patients with respiratory symptoms, GPs with a master's degree or higher〔OR (95%CI) =2.790 (1.057, 7.366) 〕and a good grasp of AR-related health knowledge〔OR (95%CI) =3.537 (2.015, 6.209) 〕were more likely to make a differential diagnosis of AR from other illnesses, GPs with a good grasp of AR-related health knowledge〔OR (95%CI) =4.397 (0.534, 1.576) 〕were more likely to offer patients guidance on environmental control behaviors, GPs who were familiar with nasal irrigation procedures〔OR (95%CI) =6.592 (3.038, 14.306) 〕were more likely to recommend nasal irrigation, and GPs knowing about immunotherapy〔OR (95%CI) =1.881 (1.087, 3.254) 〕, accurately answering questions on the principles of treatment〔OR (95%CI) =128.330 (16.628, 990.402) 〕or their institution providing some/all laboratory testing services〔OR (95%CI) =2.210 (1.299, 3.760) 〕were prone to recommend immunotherapy. Conclusion Despite their low awareness levels of AR expertise and guidelines, and unsatisfied practice standardization, GPs in primary care in Chaoyang District demonstrated proactive attitude towards continuing education and carrying out standardized AR treatment in primary care. As high awareness levels of AR-related knowledge and guidelines promote the practice standardization, relevant trainings for GPs in primary care should be strengthened, and AR-related guidelines applicable to primary care should be developed, which can provide support for the standardization of AR treatment at the primary care level.
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