Allergic-rhinitis related knowledge, diagnosis, and treatment among general practitioners in Chaoyang District, Beijing^☆

Abstract

Background: Allergic rhinitis (AR) is a highly prevalent chronic non-communicable disease. The research on the understanding and treatment of AR in China is mainly conducted by otorhinolaryngology specialists, but rarely by general practitioners (GPs). And recommendations on the diagnosis and treatment of AR in primary care are also insufficient.
Objective: To explore the knowledge of AR and diagnosis and treatment capacities related to AR in GPs.
Methods: By using simple random sampling, 432 GPs from 21 community health centers of Chaoyang District of Beijing were chosen between August and September 2020. The survey questionnaire was developed based on the Guidelines for the Diagnosis and Treatment of Allergic Rhinitis (Tianjin, 2015) (China 2015 AR Guidelines) and Allergic Rhinitis and Its Impact on Asthma (ARIA) Guidelines:2010 Revision, and its 2016 annual revision following expert consultation and a pre-survey. The questionnaire encompassed basic information, understanding to AR, diagnostic and therapeutic behaviors, training, and support needs regarding AR of GPs.
Results: There were 383 out of 432 total distributed questionnaires returned, with a response rate of 88.7 %. Only 0.8 % (3/383) of the GPs correctly responded to all of the questions on typical AR symptoms, diagnosis, treatment principle, first-line drug categories, and regimens suggested by guidelines. 32.4 % (124/383) of the GPs reported that they knew Guidelines for AR, including China 2015 AR Guidelines and ARIA Guidelines, their sources of knowledge were from online continuing education platform, such as www.haoyisheng.com, www.dxy.cn and social media such as WeChat. When treating each patient with a respiratory disease, the percentage of GPs differentiating AR from other conditions, providing recommendations on environmental control, suggesting nasal rinsing, recommending other treatments instead of immunotherapy, and referring the patient to the specialty department without any treatment, was 59.8 % (229/383), 37.1 % (142/383), 17.8 % (68/383), 49.4 % (189/383), and 13.1 % (50/383), respectively. In terms of pharmacological treatment, 17.5 % (67/383) of GPs reported their facilities offered all four categories of first-line AR medications. As for AR-related training, 75.7 % (366/383) of the GPs reported not having taken any AR-related training in 2019;and 91.7 % (266/290) needed the training. And 95.6 % (290/383) of the GPs reported AR should be treated standardized in the community. The Logistic regression analysis revealed that when encountering patients with respiratory symptoms, GPs with a master's degree or higher〔OR (95 %CI) =2.790 (1.057, 7.366) 〕and a good understanding of AR-related health knowledge〔OR (95 %CI) =3.537 (2.015, 6.209) 〕were more likely to distinguish AR from other illnesses, GPs with a good understanding of AR-related health knowledge〔OR (95 %CI) =4.397 (0.534, 1.576) 〕were more likely to offer patients guidance on environmental control behaviors, GPs who were familiar with nasal irrigation procedures〔OR (95 %CI) =6.592 (3.038, 14.306) 〕were more likely to recommend nasal irrigation, and GPs knowing about immunotherapy〔OR (95 %CI) =1.881 (1.087, 3.254) 〕, accurately answering questions on the principles of treatment〔OR (95 %CI) =128.330 (16.628, 990.402) 〕or their facilities providing some/all laboratory testing services〔OR (95 %CI) =2.210 (1.299, 3.760) 〕were prone to recommend immunotherapy.
Conclusion: Despite insufficient knowledge of AR expertise and guidelines, and unsatisfied practice, GPs in Chaoyang District demonstrated proactive attitude towards continuing education and carrying out standardized AR treatment in primary care. As good understanding of AR-related knowledge and guidelines can promote quality of practice, relevant training for GPs should be strengthened, and AR-related guidelines applicable to primary care should be developed, which can provide support for the best practice of AR treatment in primary care.

Keywords

Rhinitis / Allergic / General practitioners / Clinical work ability / Level of knowledge / Diagnosis and treatment behavior / Training requirement

Declarations

Not applicable.

Authors' contributions

Conceptualization, C.N. and Z.Y.; Methodology, C.N. and Z.Y.; Data curation, C.N. and Z.Y.; Formal analysis, C.N. and Z.Y.; Funding acquisition, not applicable; Project administration, not applicable; Resources, not applicable; Supervision, C.N. and Z.Y.; Validation, C.N. and Z.Y.; Writing—original draft, C.N. and Z.Y.; Writing—review and editing, C.N. and Z.Y. All authors have read and agreed to the published version of the manuscript.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Availability of data and materials

Not applicable.

Declaration of competing interest

The authors declare that they have no competing interests.

Funding

Not applicable.

Acknowledgements

Not applicable.

Authors' other information

Not applicable.

References

[1] Ma TT, Zhuang Y, Shi HY, et al. Analysis of the characteristics of seasonal allergic rhinitis induced by chenopodiaceae pollen in the grassland area of inner Mongolia. (Chinese). Chin J Otorhinolaryngol Head Neck Surg. 2021; 69(5):471-477. doi: 10.3760/cma.j.cn115330-20200713-00584.

[2] Yang YP, Feng J, Wang Y, et al. Analysis of the prevalence of allergic rhinitis among medical students in Urumqi and related health and lifestyle factors. (Chinese). J Xinjiang Med Univ. 2019; 42(9):1206-1210. doi: 10.3969/j.issn.1009-5551.2019.09.023.

[3] Han J. Study on the psychological status of patients with allergic rhinitis and its correlation with quality of life. (Chinese). Chin J Otorhinolaryngol Head Neck Surg. 2018; 25(4):189-191. doi: 10.16066/j.1672-7002.2018.04.005.

[4] Zhang FY, Nie CJ, Wang L, et al. The disease burden of patients with allergic rhinitis from a hospital surveillance in Beijing. Sustainability. 2017; 9(3):427. doi: 10.3390/su9030427.

[5] Cheng L, Chen JJ, Fu QL, et al. Chinese society of allergy guidelines for diagnosis and treatment of allergic rhinitis. Allergy Asthma Immunol Res. 2018; 10(4):300-353. doi: 10.4168/aair.2018.10.4.300.

[6] Guo HQ, Ning YH, Chen L, et al. Study on health-related behaviors and chronic disease prevalence among middle-aged and young people in the community under the "Healthy China 2030" initiative. (Chinese). Prim Med Forum. 2021; 25(12):1660-1663. doi: 10.19435/j.1672-1721.2021.12.014.

[7] Yu QL, Lan JP, Wang P. Survey on the current status of standardized treatment of patients with allergic rhinitis. (Chinese). Chin Med Abstr (Otorhinolaryngol). 2019; 34(4):254-255. doi: 10.19617/j.issn1001-1307.2019.04.254.

[8] Zhu LP, Lin Y, Zhang S, et al. Survey on self-reported diagnosis and treatment status of patients with allergic rhinitis in Nanjing. (Chinese). Chin J Integr Med Otorhinolaryngol. 2017; 25(6):469-473. doi: 10.16542/j.cnki.issn.1007-4856.2017.06.021.

[9] Wu XL, Bai ZX. Analysis of factors inflfluencing medication adherence in patients with allergic rhinitis. (Chinese). Chongqing Med. 2020; 49(15):2524-2527 2532. doi: 10.3969/j.issn.1671-8348.2020.15.026.

[10] Subspecialty Group of Rhinology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck SurgeryChinese guidelines for diagnosis and treatment of allergic rhinitis. (Chinese). Chin J Otorhinolaryngol Head Neck Surg. 2016;51(1):6-24. doi: 10.3760/cma.j.issn.1673-0860.2016.01.004.

[11] Brozek JL, Bousquet J, Baena-Cagnani CE, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010; 126(3):466-476. doi: 10.1016/j.jaci.2010.06.047.

[12] Brozek JL, Bousquet J, Agache I, et al. Allergic rhinitis and its impact on asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017; 140(4):950-958. doi: 10.1016/j.jaci.2017.03.050.

[13] Hu SJ, Wei P, Kou W, et al. Meta-analysis of the prevalence and risk factors of allergic rhinitis. (Chinese). J Clin Otorhinolaryngol Head Neck Surg. 2017; 31(19):1485-1491. doi: 10.13201/j.issn.1001-1781.2017.19.006.

[14] Li TC, Duan JB, Li J, et al. Analysis of the prevalence and risk factors of allergic rhinitis in Beijing. (Chinese). Chin J Public Health. 2015; 31(1):53-55. doi: 10.11847/zgggws2015-31-01-16.

[15] Wang XD, Zheng M, Lou HF, et al. An increased prevalence of self-reported allergic rhinitis in major Chinese cities from 2005 to 2011. Allergy. 2016; 71(8):1170-1180. doi: 10.1111/all.12874.

[16] Central Committee of the Communist Party of China. Opinions on deepening the reform of the medical insurance system. (Chinese). (2020-02-25)[2022-05-25]. Available from: https://www.waizi.org.cn/file/79435.html.

[17] Ryan D, Grant-Casey J, Scadding G, et al. Management of allergic rhinitis in UK primary care: baseline audit. Prim Care Respir J. 2005; 14(4):204-209. doi: 10.1016/j.pcrj.2005.03.009.

[18] Urrutia-Pereira M, Fernández C, Valentin-Rostan M, et al. Primary care physicians’ knowledge about allergic rhinitis and its impact on asthma (ARIA guidelines): a comparative Brazilian/Paraguayan/Uruguayan pilot study. Rev Alerg Mex. 2018; 65(4):321-330. doi: 10.29262/ram.v65i4.525.

[19] Osarogiagbon W, Osaghae D. Knowledge and management of allergic rhinitis by general practitioners in Benin City. Port Harcourt Med J. 2017; 11(3):141. doi: 10.4103/phmj.phmj_25_17.

[20] Yang QT, Chen JJ, Tan GL, et al. Expert consensus on the treatment of allergic rhinitis with intranasal corticosteroids (2021, Shanghai). (Chinese). Chin J Otorhinolaryngol Skull Base Surg. 2021; 27(4):365-371. doi: 10.11798/j.issn.1007-1520.202140001.

[21] Aggarwal B, Shantakumar S, Hinds D, et al. Asia-pacific survey of physicians on Asthma and Allergic Rhinitis (ASPAIR): physician beliefs and practices about diagnosis, assessment, and treatment of coexistent disease. J Asthma Allergy. 2018; 11:293-307. doi: 10.2147/JAA.S180657.

[22] Abdullah B, Kandiah R, Hassan NFHN, et al. Assessment of perception, attitude, and practice of primary care practitioners towards allergic rhinitis practice guidelines: development and validation of a new questionnaire. World Allergy Organ J. 2020; 13(12):100482. doi: 10.1016/j.waojou.2020.100482.

[23] Guo P. The impact of a hierarchical diagnostic and treatment system on medication adherence in patients with allergic rhinitis. (Chinese). Chin Health Ind. 2020; 17(13):3-5. doi: 10.16659/j.cnki.1672-5654.2020.13.003.

[24] Editorial Board of Chinese Journal of Otolaryngology Head and Neck Surgery, Rhinology Group, Chinese Medical AssociationChinese Guidelines for Diagnosis and Treatment of Allergic Rhinitis (2022, revised edition). (Chinese). Chin J Otorhinolaryngol Head Neck Surg. 2022; 57(2):106-129. doi: 10.3760/cma.j.cn115330-20211228-00828.

[25] Xinhua News Agency. Carry high the banner of socialism with Chinese characteristics and unite to build a modern socialist country in all respects - Report at the 20th National Congress of the Communist Party of China. (Chinese). (2022-10-25)[2022-10-25]. Available from: http://www.gov.cn/xinwen/2022-10/25/content_5721685.htm.