Acute maxillary sinusitis in general practice: a decision problem.

Abstract

This paper describes a qualitative analysis of a decision problem of acute maxillary sinusitis in general practice. The criteria and expected outcomes on which general practitioners (GPs) base their choice of a management strategy are presented. Structured open-ended interviews, all done by the first author, were transcribed, and summarized for each management strategy. These summaries were sent back to the experts for verification. Eight expert GPs from The Netherlands participated; all had been practising for at least three years, and had conducted postgraduate research into upper respiratory tract infections. There was a high degree of consensus among the eight GPs. While most practitioners generally considered the prevention of complications of therapy more important than the prevention of complications of disease, patients at risk (e.g., the elderly, children, patients with other chronic diseases, and patients in weakened condition) of complications of acute sinusitis (e.g., chronic sinusitis) were considered an exception to this rule, possibly because the complications of sinusitis are more serious than those of its therapy. Major differences between the GPs concerned the timing of decisions (e.g. prescribing antibiotics after 5 or 21 days of complaints while local therapy was used). Although this study gives no answer as to which management strategy is optimal, the results served as a basis in the development of the Dutch "Sinusitis in general practice standard". In order further to develop the optimal strategy, in future research, the probabilities and weights attached to the criteria and expected outcomes have to be quantified.