A qualitative investigation of the allergic rhinitis network from the perspective of the patient

Biljana Cvetkovski,Kwok Yan,Sinthia Bosnic-Anticevich,Rachel Tan,Vicky Kritikos,Elizabeth Azzi,Pamela Srour

doi:10.1038/s41533-019-0147-5

Abstract

Patient self-selection of over-the-counter medicines for the management of allergic rhinitis is suboptimal. The mapping of the allergic rhinitis network demonstrates that patients’ decisions with regards to their allergic rhinitis management can be influenced by up to 11 individuals/resources (alters). This study aimed to identify the role of alters within the allergic rhinitis network and identify the factors that determined their degree of influence as perceived by the patient. This research was a qualitative exploration embedded in an empirical framework and social network theory. People with allergic rhinitis were interviewed about their network and transcripts were analysed deductively and inductively. Transcripts were coded by researchers independently and then discussed until agreement was reached. Forty-one participants described the roles of 17 alters on their allergic rhinitis management. The roles of alters fell within five categories: diagnosis, medication prescription/supply/administration, medication recommendation, information about allergic rhinitis and emotional support. Participant interactions with these alters were often acute and had a long standing effect, with the participants often navigating the long-term management on their own. The significance of the influence of each alter on their allergic rhinitis management was dependent on the level of trust in their relationship, impact of the role made to the participants’ day-to-day management of allergic rhinitis and/or the participant’s beliefs. Allergic rhinitis management was fragmented and had opportunity to be improved by developing strategies, resources and policies to support self-management in collaboration with patients and health-care professionals.

Highlights

All over the world, people with allergic rhinitis (AR) manage their symptoms with medicines that are purchased over the counter (OTC) in community pharmacies.[1,2,3,4,5,6] In Australia, the range of medicines that are available on an open shelf, without having to consult or interact with a pharmacist, is broad and includes antihistamines and intranasal corticosteroids
While we already knew that people with AR obtain advice from a wide range of sources, we know that the advice being provided is suboptimal, fragmented and not supported with follow-up review
This research demonstrates that, participants identified themselves as having AR, very few described an official diagnosis and were making medication management decisions based on information provided many years ago without follow-up review

Summary

Introduction

People with allergic rhinitis (AR) manage their symptoms with medicines that are purchased over the counter (OTC) in community pharmacies.[1,2,3,4,5,6] In Australia, the range of medicines that are available on an open shelf, without having to consult or interact with a pharmacist, is broad and includes antihistamines and intranasal corticosteroids. Medication management of a chronic disease is only a fraction of what is required for successful self-management.[9] While there is evidence to demonstrate the benefits of self-management in other chronic diseases such as asthma and diabetes,[9,10,11] the continued burden and suboptimal management of AR symptoms in the community demonstrate that AR self-management needs to be reviewed and better supported in practice. Prior to developing and optimising AR management strategies, we need to understand the influences behind patients’

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Conclusion