Editorial

Abstract

Patient compliance is the largest "elephant in the room" in the management of chronic diseases and chronic rhinosinusitis (CRS), and an area clearly worthy of further research and innovative solutions. Although studies have not yet been performed within our subspecialty, studies performed in other chronic diseases have demonstrated that this is a major barrier in terms of the management of chronic disease states. In one study evaluating the use of preventive medications following a myocardial infarction, rates of adherence for medical therapy ranged between 35.9% and 49%. Usage rates remained low and were only slightly higher when the medication was provided at no cost.1 In another study, performed in Québec, where there is a strong social program to reduce or eliminate prescription co-pays, over 30% of prescriptions were never filled (primary nonadherence) in a primary care setting. The level of primary nonadherence in this study rose from 30% to nearly 40% within the category of "rhinitis" management.2 One would hope that the rate of primary nonadherence would be lower within a specialty setting, but how many of our patients actually use the medications that we prescribe on an ongoing regular basis? Based upon the information from other chronic diseases, I have no doubt that it is much lower than we anticipate. In this edition of IFAR, Cingi et al.3 evaluate the impact of a mobile patient engagement application for asthma patients. This important study showed a significant improvement in the Rhinitis Quality-Of-Life Questionnaire (RQLQ) at 1 month, and, in the asthma patients, the Asthma Control Test (ACT) at the end of the study (3 months) in the intervention groups as opposed to the control groups. One of the early studies on my patient population showed that if we could completely resolve the persistent and typically asymptomatic inflammation that persists following surgery for CRS, no patients required revision surgical intervention over the nearly 8-year mean follow-up period. 4 The question therefore arises as to how much we could improve our surgical results, or perhaps even decrease the need for surgical intervention, with active and ongoing patient education and intervention, and how we could make this intervention cost effective.