Primary care management of allergic rhinitis: A cross-sectional study in four ASEAN countries

Abstract

Background: In primary care, general practitioners (GPs) and pharmacists are tasked with the frontline responsibility of identifying and managing allergic rhinitis (AR) patients. There are currently no consolidated data on current treatment practices, patient compliance, and usage of guidelines within Southeast Asian Nations (ASEAN).Objective: To assess the attitudes and practices on AR of GPs and pharmacists in 4 ASEAN countries (Philippines, Indonesia, Thailand, and Malaysia).Methods: A cross-sectional survey of 329 GPs and 548 pharmacists was conducted from May to November 2019. Participants answered a questionnaire focused on their i) current practice in the management of AR, ii) views on patient compliance, iii) understanding and usage of guidelines.Results: Clinical history was the most preferred method to diagnose AR by 95.4% of GPs and 58.8% of pharmacists. Second-generation antihistamines were the most widely available treatment option in GP clinics and pharmacies (94.8% and 97.2%) and correspondingly the most preferred treatment for both mild (90.3%, 76.8%) to moderate-severe rhinitis (90.3%, 78.6%) by GPs and pharmacists, respectively. Loratadine was ranked as the most preferred 2nd generation antihistamines (GP vs pharmacists: 55.3% vs 58.9%). More than 90% of GPs and pharmacists ranked length and efficacy of treatment as important factors that increase patient compliance. Awareness of the ARIA guidelines was high among GPs (80%) and lower among pharmacists (48.4%). However, only 63.3% of GPs and 48.2% of pharmacists knew how to identify AR patients.Conclusion: The survey in the 4 ASEAN countries has identified a need to strengthen the awareness and use of ARIA guidelines among primary care practitioners. Adherence to ARIA guidelines, choosing the appropriate treatment option and prioritizing factors that increase patient compliance may contribute to better management outcomes of AR at the primary care practice.

Closing the knowledge gap in Malaysian pharmacists: A virtual Allergic Rhinitis Boot Camp initiative

“…As the study is piloted in Malaysia, the findings should be interpreted with caution when extrapolating beyond Malaysia. However, it has been shown in previous studies that the pharmacist behaviour across ASEAN is quite similar [ 20 ]. The boot camp sought to address the knowledge gap in pharmacy practice but we have yet to evaluate if it has impact to the actual clinical practice.…”

“…The questionnaire for the assessment was designed based on the questionnaire deployed in the published survey “Primary care management of allergic rhinitis: a cross-sectional study in four ASEAN Countries” [ 20 ]. The questionnaire consisted of 19 questions divided into five sections:…”

“…Within Asia-Pacific, the findings from a recently published cross-sectional primary care study, conducted among 4 countries (Philippines, Indonesia, Thailand and Malaysia), further demonstrated that the awareness of ARIA guidelines was high among GPs (80%) but notably lower in pharmacists (48.4%). Only 63.3% of GPs and 48.2% of pharmacists in this study knew how to identify AR patients [ 20 ]. These findings emphasized the unmet need to strengthen the understanding on AR awareness and the use of relevant guidelines among pharmacists.…”

Current perspectives on the management of allergic rhinitis in selected Asia-Pacific countries: a meeting report

“…Second-generation non-sedating H 1 -antihistamines and nasal corticosteroids are key components of the treatment strategy for patients with AR as per ARIA recommendations; 7,11 this approach was confirmed by the expert panel. Ongoing education of healthcare providers, GPs and specialists 24 is considered useful to improve AR disease management in the region and ensure that treatment aligns with recommendations in major international guidelines. Providing comparative data about the advantages of bilastine relative to other secondgeneration H 1 antihistamines may be useful in terms of guiding treatment selection.…”

Pharmacological Management of Allergic Rhinitis: A Consensus Statement from the Malaysian Society of Allergy and Immunology

“…Nonetheless, knowledge gaps have been identified between recommended treatments for AR and actual clinical practice in a study in the Southeast Asian countries. 8 Although 80% of GPs are aware of international guidelines, majority of primary care providers in Malaysia do not prescribe INCS as one of the main therapies in AR. 8 Moreover, the selection and personalization of pharmacotherapy to control symptoms and improve quality of life can be challenging in uncontrolled and severe AR.…”