Mohan Shaulnie, Sisler Katelin, Christopher Kara, Hentzelman Joshua, Antisdel Jastin
Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, Saint Louis, Missouri, USA.
Am J Rhinol Allergy. 2014 Nov-Dec;28(6):487-92. doi: 10.2500/ajra.2014.28.4101.
Sinusitis is diagnosed in 31 million individuals annually and has a significant impact on health care expenditures. Otolaryngologists understand that patient expectations, health knowledge, and the use of therapeutic options by patients and primary care physicians (PCPs) vary greatly. The intent of this study was to elucidate differences in the perspectives of patients, PCPs and otolaryngologists regarding the diagnosis and treatment of sinonasal disease.
Three surveys were developed with questions targeting sinonasal infections: specifically, prevalence, diagnosis, physician prescribing patterns, treatment alternatives, and referral patterns to tertiary level physicians. Surveys were distributed to adult patients (n = 113) at general health fairs, whereas surveys for PCPs (n = 54) and otolaryngologists (n = 40) were obtained from teaching conferences and professional networking events.
In a description of viral upper respiratory tract infections (URIs), 43% of patients attributed symptoms to allergic rhinitis, 28% to URIs, and 28% to sinus infections. Despite this, 37% of patients still expected anti-bacterial agents. In patients with acute rhinosinusitis (ARS), 44% of patients would wait <1 week to see a physician whereas 82% of otolaryngologists and 57% of PCPs felt waiting 1 week or more was appropriate. In an ambulatory care setting, 45% of PCPs would chose to treat patients with 5 days of ARS symptoms whereas 32% of otolaryngologists would treat patients (p = .22). For ARS, 70% of patients expected antibiotics. Seventy percent of PCPs stated that they would refer a patient to an otolaryngologist after a single episode of sinusitis.
Patients with sinonasal symptoms confuse URIs for sinusitis and expect unnecessary treatment with antibiotics. PCPs and otolaryngologists vary regarding indications for presentation to a physician, approaches to therapy, and indications for referral to a tertiary provider in their respective practices.
鼻窦炎每年在3100万人中被诊断出来，对医疗保健支出有重大影响。耳鼻喉科医生了解患者期望、健康知识以及患者和初级保健医生（PCP）对治疗方案的使用差异很大。本研究的目的是阐明患者、初级保健医生和耳鼻喉科医生在鼻窦疾病诊断和治疗方面观点的差异。
针对鼻窦感染设计了三项调查问卷，具体涉及患病率、诊断、医生处方模式、治疗选择以及转诊至三级医生的模式。调查问卷分发给健康博览会上的成年患者（n = 113），而针对初级保健医生（n = 54）和耳鼻喉科医生（n = 40）的调查问卷则来自教学会议和专业社交活动。
在描述病毒性上呼吸道感染（URI）时，43%的患者将症状归因于过敏性鼻炎，28%归因于URI，28%归因于鼻窦感染。尽管如此，37%的患者仍期望使用抗菌药物。在急性鼻-鼻窦炎（ARS）患者中，44%的患者会在不到1周的时间内就医，而82%的耳鼻喉科医生和57%的初级保健医生认为等待1周或更长时间是合适的。在门诊环境中，45%的初级保健医生会选择治疗有5天ARS症状的患者，而32%的耳鼻喉科医生会治疗患者（p = 0.22）。对于ARS，70%的患者期望使用抗生素。70%的初级保健医生表示，他们会在患者单次鼻窦炎发作后将其转诊给耳鼻喉科医生。
有鼻窦症状的患者将URI与鼻窦炎混淆，并期望进行不必要的抗生素治疗。初级保健医生和耳鼻喉科医生在就医指征、治疗方法以及各自实践中转诊至三级医疗服务提供者的指征方面存在差异。
