Development of an allergy management support system in primary care

Blok, Bertine Mj Flokstra de; Molen, Thys van der; Christoffers, Wianda; Kocks, Janwillem; Oei, R.L.; Elberink, J N Oude; Roerdink, Emmy M; Schuttelaar, Marie L A; Velde, J. L. van der; Brakel, Thecla M.; Dubois, Anthony

doi:10.2147/jaa.s123260

Cited by 18 publications

(17 citation statements)

References 22 publications

(29 reference statements)

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“…Ongoing allergy educational support for GPs now needs to be considered, as an important role of GPwSIs, especially given the lack of allergy training . In the Netherlands, an allergy management support system has been developed for use in primary care . Similar initiatives could be useful in the UK.…”

Section: Discussionmentioning

confidence: 63%

The impact of a General Practitioner‐led community paediatric allergy clinic: A service evaluation

El‐Shanawany

Wade

Holloway

2019

Clin Experimental Allergy

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Background: The NHS is not meeting the nation's allergy needs. There are insufficient allergy specialists, with variable care across the country. General practitioners (GPs) are lacking in allergy training. London's Whittington Hospital created a GP with Special Interest (GPwSI) community paediatric allergy clinic, running alongside preexisting hospital clinics, to address local unmet needs, aiming to provide equity for patients, improve patient experience and decrease secondary care burden. Objectives: To establish whether improvements have occurred within the service by introducing a GPwSI-led community paediatric allergy clinic alongside providing GP education and referral pathways. This study asks: (a) Have allergy-related hospital attendances decreased with the provision of the community service? (b) Are patients seen in the appropriate clinic? (c) What proportion of patients require GPwSI followup? (d) Is there good patient satisfaction? (e) Have allergy clinic waiting times changed? Methods: Numbers of allergy-related hospital attendances and waiting times in 2013, 2014 and 2016 were assessed. Data were analysed regarding proportions of patients requiring GPwSI follow-up or referral from the GPwSI community clinic to hospital. Patient satisfaction was assessed. Results: Since introducing the GPwSI community service the burden on secondary care has decreased, with reduced hospital attendances for allergy clinic patients, although waiting times have increased. In 2013, 65% of allergy clinic patients attended other hospital services for allergy-related complaints prior to their first allergy clinic appointment. This was reduced to 27.3% (community) and 36.9% (hospital) in 2014 and maintained in 2016 (27.5% community and 37.5% hospital), P < 0.01. Patient satisfaction in the hospital and community clinics is very high. Clinical Relevance: This integrated, multidisciplinary Paediatric Allergy Service could provide a model to improve the unmet allergy need both in the UK and beyond. This GPwSI model could also be applied to other chronic diseases in both adults and children, improving care beyond allergy. K E Y W O R D S food allergy, pediatrics | 691 EL-SHANAWANY Et AL.

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Section: Discussionmentioning

confidence: 63%

The impact of a General Practitioner‐led community paediatric allergy clinic: A service evaluation

El‐Shanawany

Wade

Holloway

2019

Clin Experimental Allergy

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“… 23 With a limited supply per capita of allergists/immunologists (and availability of sub-lingual immunotherapy in primary care), the role of the GP in treating allergy has never been more important and upskilling our HCPs may be the solution to minimising AR-related impact on QOL in the community. 21 , 24 …”

Section: Discussionmentioning

confidence: 99%

A patient-centric analysis to identify key influences in allergic rhinitis management

Cvetkovski

Tan

Kritikos

et al. 2018

npj Prim Care Resp Med

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Allergic rhinitis (AR) is increasingly becoming a patient self-managed disease. Just under 70% of patients purchasing pharmacotherapy self-select their treatment with no health-care professional intervention often resulting in poor choices, leading to suboptimal management and increased burden of AR on the individual and the community. However, no decision is made without external, influencing forces. This study aims to determine the key influences driving patients’ decision-making around AR management. To accomplish this aim, we utilised a social network theory framework to map the patient’s AR network and identify the strength of the influences within this network. Adults who reported having AR were interviewed and completed an AR network map and AR severity and quality of life questionnaires. Forty one people with AR completed the study. The AR networks of the participants had a range of 1–11 influences (alters), with an average number of 4 and a median of 5. The larger the impact of AR on their quality of life, the greater the number of alters within their network. The three most commonly identified alters were, general practitioners, pharmacists and the participants’ ‘own experience’. The strength of the influence of health-care professionals (HCPs) was varied. The proportion of HCPs within the AR network increased as the impact of AR on their quality of life increased. By mapping the AR network, this study demonstrated that there are multiple influences behind patient’s decisions regarding AR management but the role of the HCP cannot be dismissed.

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“…Participating patients in the intervention and control group completed the AMSS questionnaire and sent the questionnaire to the AMSS researchers for analysis together with the sIgE test results. Previously developed algorithms (for adults and children) were used to allocate patients to predefined diagnostic categories and consequent recommendations for management [ 15 ]. In addition, the AMSS questionnaire, sIgE test results and resultant AMSS recommendations were checked by allergy specialists for inaccuracies or ambiguities.…”

Section: Methodsmentioning

confidence: 99%

“…Since the specialist-based allergy care model will become unsustainable with increasing allergy prevalence, a new allergy care model with a more important role for the GP is mandatory [ 8 ]. Therefore, we developed an allergy management support system (AMSS) to support GPs in diagnosing and managing patients with IgE-mediated allergy in primary care [ 11 , 15 ]. Based on a patient-reported history questionnaire and specific IgE (sIgE) blood test results, we could demonstrate that the AMSS is able to provide a probable diagnosis and recommendations on management of allergic disorders for GPs [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, we developed an allergy management support system (AMSS) to support GPs in diagnosing and managing patients with IgE-mediated allergy in primary care [ 11 , 15 ]. Based on a patient-reported history questionnaire and specific IgE (sIgE) blood test results, we could demonstrate that the AMSS is able to provide a probable diagnosis and recommendations on management of allergic disorders for GPs [ 15 ]. The primary aim of this pilot study was to test the feasibility of an AMSS for primary care.…”

Section: Introductionmentioning

confidence: 99%

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The feasibility of an allergy management support system (AMSS) for IgE-mediated allergy in primary care

Blok

Brakel

Wubs

et al. 2018

Clin Transl Allergy

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BackgroundThe allergy management support system (AMSS) was developed to assist general practitioners (GPs) to handle the increasing burden of allergic diseases and facilitates the diagnosis and management of allergy. The aim of this cluster-randomized controlled pilot study was to test the feasibility of this AMSS for primary care.MethodsGPs received diagnostic and management recommendations generated by the AMSS in addition to sIgE-test results (intervention) or GPs received sIgE-test results only (control). The AMSS recommendations are based on the previously developed patient-completed AMSS questionnaire and sIgE-test results. The AMSS was considered feasible when > 70% of the AMSS recommendations were sent to the GP within ten working days of sIgE-testing. GPs completed a questionnaire on their diagnosis and management before (T1) and after (T2) receiving sIgE test results. Agreement and disagreement concerning diagnosis, medication and referrals between GPs and AMSS was investigated at T1 and T2. A total agreement score between GPs and AMSS was calculated. GPs in the intervention group completed a questionnaire to evaluate the utility of the AMSS. Semi-structured interviews were used to explore the motivation of GPs who did not include patients in this pilot study.ResultsTwenty-seven GPs included 101 patients. Forty-two patients (72%) completed the AMSS questionnaire in the intervention group. The majority of the AMSS recommendations (93%) were returned to the GP within 10 working days after sIgE-test results were known [mean (SD) 4.7 (4.0) working days]. GPs in the intervention group reported largely following the AMSS recommendations in 71% of cases. The total agreement scores concerning diagnosis were significantly higher (p < 0.001) in the intervention group than the control group [mean (SD); 0.9 (1.8) vs − 0.8 (1.0)]. The agreement concerning medication or referral between GPs and AMSS did not differ between the intervention and the control group. GPs in the intervention group were reasonably positive about the AMSS. Not enrolling patients was not caused by anticipated ineffectiveness of the AMSS.ConclusionThe AMSS can be considered to be feasible for primary care. GPs tend to follow the AMSS recommendations. The AMSS may contribute to the empowerment of GPs to better manage allergy patients in primary care.Trial registration ISRCTN ISRCTN36780877. Registered 23 November 2017 (retrospectively registered)

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Development of an allergy management support system in primary care

Cited by 18 publications

References 22 publications

The impact of a General Practitioner‐led community paediatric allergy clinic: A service evaluation

The impact of a General Practitioner‐led community paediatric allergy clinic: A service evaluation

A patient-centric analysis to identify key influences in allergic rhinitis management

The feasibility of an allergy management support system (AMSS) for IgE-mediated allergy in primary care

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