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

Abstract

ObjectivesTo explore patient views and perspectives of current management of chronic rhinosinusitis (CRS) in primary and secondary care.DesignSemistructured qualitative telephone interviews as part of the MACRO programme (Defining best Management for Adults with Chronic RhinOsinusitis).SettingPrimary care and secondary care ear, nose and throat outpatient clinics in the UK.ParticipantsTwenty-five patients consented to in-depth telephone interviews. Transcribed recordings were managed using NVivo software and analysed using inductive thematic analysis.ResultsCRS 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.ConclusionsPatients 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.

Self-referral of Chinese patients with advanced chronic kidney disease and treatment decision-making: A qualitative study

“…Self-referral communication consists of formal consultation, risk communication and other unplanned communication. In our study, participants described challenging consultation experience about exchanging necessary self-referral information, align with previous studies reported poor consultation experience for long-time waiting and rush discussion [39]. [40].…”

Antibiotic usage in chronic rhinosinusitis: analysis of national primary care electronic health records

“…This suggests that in the majority of patients where the diagnosis of chronic disease is clear, antibiotics are not being prescribed, in keeping with EPOS guidelines (5). Of those who have received an antibiotic, it is still possible that the antibiotics have been prescribed for acute infective exacerbations, which can be frequent in CRS; recent qualitative interviews with primary care physicians, antibiotics were prescribed for acute exacerbations, purulent discharge and occasionally in response to patient pressure if antibiotics have been helpful in previous episodes (6).…”

“…The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS 2012) published treatment guidelines and a research strategy for CRS, emphasising where limited evidence restricts care (5), but there are currently no NICE guidelines for managing patients with RCS. Awareness and uptake of EPOS is variable, and both GPs and specialist ENT surgeons share uncertainty regarding the role of antibiotics (6).…”

“…Longer-term antibiotic use in secondary care has a low-grade recommendation in EPOS reflecting conflicting evidence from 2 RCTs (9, 10) resulting in a call for further trials (8,(11)(12)(13). There are no NICE guidelines and uptake of EPOS is variable (6). A recent ENT-UK commissioning guideline (14) acknowledges the lack of high quality trials and does not recommend routine antibiotic use for CRS in primary care.…”

Maximising recruitment to a randomised controlled trial for chronic rhinosinusitis using qualitative research methods: the MACRO conversation study

“…Trial specific training materials were prepared based on trial team experience, qualitative work from the development stage of MACRO [17,18], existing published research and published investigator training materials from the QuinteT team [19][20][21][22][23]. Particular emphasis was placed on general recruitment challenges, maintaining equipoise, communicating the concept of randomisation and how to manage perceived patient preference in particular reference to the MACRO trial (see Table 2).…”