Abstract
BackgroundPrimary care practitioners (PCPs), being the front liners, play an important role in treating allergic rhinitis (AR). As there is no proper tool to assess their perception, attitude, and practice in utilizing the guidelines, we aimed to develop and validate a new questionnaire for such purpose. MethodsThe development phase consists of both literature and expert panel review. The validation phase consists of content validity, face validity, and construct validity. Cronbach's alpha was used to verify internal consistency. The development phase produced a questionnaire with 3 domains: perception, attitude, and practice consisting of 60 items (PAP-PCP questionnaire). Item response theory analysis for perception demonstrated the difficulty and discrimination values were acceptable except for 3 items. Exploratory factor analysis for attitude and practice domains showed the psychometric properties were good except for 3 items in practice domain. Experts judgement was used to decide on the final selection of questionnaire which consists of 59 items. ResultsThe final validated questionnaire has 3 domains with 59 items. All domains had Cronbach's alpha above 0.65 which was reliable. 302 physicians completed the questionnaire. 98% PCPs diagnosed AR based on clinical history. Although, majority agree AR guidelines is useful (67%), they had difficulty in using it to classify AR (54.9%) and determine AR severity (73.9%). Oral anti-histamines (first and second generation) were the most prescribed (>75%) followed by intranasal corticosteroids (59%) and combined intranasal corticosteroid and oral anti-histamine (51%). Majority agreed that treatment efficacy (81.8%), adverse effects (83.8%), fear of adverse effects (73.5%), route of administration (69.4%), dosing frequency (72.5%), taste (64.6%) and cost (73.5%) affect treatment compliance. ConclusionsThe newly developed and validated questionnaire is a promising instrument in understanding the treatment gap in AR. Although further testing and refinement are needed, it provides an initial means for evaluating knowledge and understanding of PCPs in treating AR.
Highlights
Allergic rhinitis (AR) is an inflammatory disease of the nasal mucous membranes
The mean years of practising were 10.0 years and the mean estimate of total number of patients seen per week were 153.5, with mean of 10 rhinitis patients, 10 asthma patients, and 5 both rhinitis and asthmatic patients seen per week
98% primary care practitioners (PCPs) diagnosed allergic rhinitis (AR) based on clinical history
Summary
Allergic rhinitis (AR) is an inflammatory disease of the nasal mucous membranes. An allergen exposure of allergic individuals results in an immunoglobulin E (IgE)-mediated inflammatory response, which can be manifested clinically as nasal congestion, postnasal drainage, rhinorrhea, nasal itching, sneezing, and itchy or watery eyes.[1,2] For patients suffering from AR, primary care practitioners (PCPs) are often their first source of medical advice.[3] It is one of the top-ten reasons for a visit to primary care clinics, and AR was estimated to be 10–40% of the total patient visits in approximately 50% of primary care clinics.[4,5] It has been reported in a population-based survey, that 71% of patients suffering from rhinitis visited a primary care physician and only 18% consulted an otorhinolaryngology (ORL) specialist.[5] This emphasizes the key role of PCPs in the diagnosis, treatment, and follow-up of AR.[6]. As there is no proper tool to assess their perception, attitude, and practice in utilizing the guidelines, we aimed to develop and validate a new questionnaire for such purpose
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