Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.
Curr Med Res Opin. 2012 Oct;28(10):1743-51. doi: 10.1185/03007995.2012.724393. Epub 2012 Sep 7.
General practitioners (GPs) are the healthcare professionals to whom patients with rhinitis firstly refer for their symptoms.
In the present study, we assessed drug prescriptions for allergic rhinitis (AR) and evaluated prescriptive adherence to ARIA treatment guidelines.
Data on 1379 AR patients were collected by 107 Italian GPs. Adherence to ARIA guidelines was evaluated according to AR severity classification.
AR was diagnosed by GPs as mild intermittent for 46.2% of patients, mild persistent for 26.6%, moderate-severe intermittent for 20.2%, and moderate-severe persistent for 7%; 43.7% of AR patients had concomitant asthma. The most frequently prescribed therapeutic groups were antihistamines (anti-H, 76%) and nasal corticosteroids (NCS, 46%). Anti-H were significantly used more often to treat AR alone than AR + asthma (85 vs. 68%, p < 0.001), whereas NCS were used more often to treat AR + asthma than AR alone (50 vs. 42%, p = 0.01). Among patients with only mild intermittent AR, 39% were prescribed combined therapy. Among patients with moderate-severe persistent AR, 30% of those with AR alone and 18% of those with AR + asthma were prescribed monotherapy based on anti-H. GPs were more compliant with ARIA guidelines while treating AR alone (57%) than AR + asthma (46%) patients. The adherence increased according to the severity grade and was satisfactory for moderate-severe persistent AR (89% for AR alone and 95% for AR + asthma).
Adherence to ARIA guidelines is satisfactory only for treatment of more severe patients, thus GPs often tend to treat patients independently from ARIA guidelines. Since prescription data only provide limited information to judge prescribing quality, some deviation from the gold standard are to be expected.
全科医生（GP）是患者出现鼻炎症状时首先就诊的医疗保健专业人员。
本研究评估了变应性鼻炎（AR）的药物处方，并评估了处方对 ARIA 治疗指南的依从性。
由 107 名意大利全科医生收集了 1379 名 AR 患者的数据。根据 AR 严重程度分类评估对 ARIA 指南的依从性。
GP 将 AR 诊断为轻度间歇性占 46.2%，轻度持续性占 26.6%，中度-重度间歇性占 20.2%，中度-重度持续性占 7%；43.7%的 AR 患者同时患有哮喘。最常开的治疗药物组为抗组胺药（抗-H，76%）和鼻用皮质类固醇（NCS，46%）。抗-H 治疗 AR 时的使用率明显高于 AR 合并哮喘（85%比 68%，p<0.001），而 NCS 治疗 AR 合并哮喘时的使用率高于 AR 时（50%比 42%，p=0.01）。仅有轻度间歇性 AR 的患者中，39%接受了联合治疗。中重度持续性 AR 患者中，30%单独 AR 患者和 18% AR 合并哮喘患者接受了基于抗-H 的单药治疗。治疗单纯 AR 患者时，GP 更符合 ARIA 指南（57%），而治疗 AR 合并哮喘患者时则不太符合（46%）。根据严重程度等级，对指南的依从性增加，对中重度持续性 AR 则非常满意（单独 AR 为 89%，合并哮喘为 95%）。
仅对更严重患者的治疗符合 ARIA 指南，因此 GP 经常倾向于根据 ARIA 指南之外的因素治疗患者。由于处方数据仅提供有限的信息来判断处方质量，因此可能会存在一些偏离黄金标准的情况。
