Physicians’ prescribing behaviour and clinical practice patterns for allergic rhinitis management in Italy

Abstract

Background: Despite availability of clinical guidelines, underdiagnosis, undertreatment, and poor adherence are still significant concerns in allergic rhinitis (AR) therapeutic management. We investigated clinical practice patterns and prescribing behavior of Italian healthcare professionals (HCPs) specialized in AR. Methods: One-hundred allergologists, 100 ear, nose and throat (ENT) specialists, and 150 general practitioners (GPs) were recruited. The survey assessed: socio-demographic, work experience, monthly caseload, prescription drivers. Next, HCPs were invited to retrospectively recover patients’ clinical data to investigate: AR clinical characteristics, therapy management, prescription patterns, patient adherence. Descriptive statistics, Chi-square, One-Way analysis of variance, and Two-Way Analysis of Variance were performed.Results: Allergologists visited more AR patients (31% of monthly caseload) than ENTs (21%, p<0.001), while GPs’ caseload was the lowest (6%). Clinical information of 2823 patients were retrieved of whom 1906 (67,5%) suffered from moderate/severe AR (discomfort score: 7,7±1,3) and 917 (32,4%) from mild AR (5.7±1.9). About one-third of mild patients had a discomfort score >=7. Main prescription drivers were “effective on all symptoms” (54,3% patients) and “quick symptom relief” (47,8%), whereas minor drivers were “affordable price” (13,4%) and “refundable” (8,7%). The most prescribed drugs were antihistamines and intranasal corticosteroids (79% and 55% prescriptions), followed by fixed-dose-combination of intranasal azelastine/fluticasone (19%). Polytherapy was the most common treatment strategy (59,6%). HCPs’ believe that the majority of the patients was adherent to treatment (88% with score>7).Conclusions: This survey describes the therapeutic approach adopted by Italian physicians to cope with AR and shows that HCPs underestimated AR severity and had a non-realistic perception of patients’ adherence. These findings suggest that further efforts are required to improve AR clinical management in Italy.

Prescription rate and treatment patterns for allergic rhinitis from 2010 to 2018 in South Korea: a retrospective study

“…Systemic steroids are only recommended for patients with very severe and therapy-resistant symptoms due to concerns of adverse events [21]. This pattern was not identified in other countries [11,12], and was not reported in the previous survey in Korea [13]. Further studies are required to investigate the characteristics and prognosis of patients prescribed these drugs.…”

“…These results, and changes in the guidelines, are thought to have had some effect on the prescription patterns. However, compared with the extensive use of nasal steroids in other countries [11,12], the use of nasal steroids in Korea has remained at around 10-20 %.…”

“…LTRAs, and nasal steroids [9]. However, studies have mainly focused on the treatment efficacy through randomized controlled trials, and few studies have assessed how different medications are used in clinical practice [10][11][12][13]. Ghouri N, et al [10] studied prescription of antihistamines and drugs used in nasal allergy from 2001 to 2005 in the United Kingdom (UK).…”

“…However, guidelines have since changed [8] and the types of medications have varied. Subsequently, a systematic survey of physicians was conducted in Italy [12] and the UK [11]. There were differences in prescription patterns depending on the region, indicating that research on prescription patterns in Korea is also necessary.…”

Real‐world data using mHealth apps in rhinitis, rhinosinusitis and their multimorbidities

“…Apps designed for and used in allergic rhinitis (AR) and chronic rhinosinusitis (CRS) may help to better understand these diseases and their management as well as to identify and address some unmet needs. This is particularly important in these chronic diseases which are often trivialised 9 and undertreated, 10,11 both by patients and healthcare providers. However, these new tools first need to be tested for privacy rules, acceptability, usability and cost‐effectiveness.…”