Primary Care and Population Sciences, University of Southamption, Southampton, UK.
ENT, Guys Hospital, London, UK.
BMJ Open. 2019 Apr 23;9(4):e022644. doi: 10.1136/bmjopen-2018-022644.
To explore patient views and perspectives of current management of chronic rhinosinusitis (CRS) in primary and secondary care.
Semistructured qualitative telephone interviews as part of the MACRO programme (Defining best Management for Adults with Chronic RhinOsinusitis).
Primary care and secondary care ear, nose and throat outpatient clinics in the UK.
Twenty-five patients consented to in-depth telephone interviews. Transcribed recordings were managed using NVivo software and analysed using inductive thematic analysis.
CRS has a significant impact on patients' quality of life, affecting their ability to work effectively, their social interactions and daily living. Patients seek help when symptoms become unmanageable, but can become frustrated with the primary care system with difficulties obtaining an appointment, and lack of continuity of care. Patients perceive that general practitioners can be dismissive of CRS symptoms, and patients often prioritise other concerns when they consult. Health system barriers and poor communication can result in delays in accessing appropriate treatment and referral. Adherence to intranasal steroids is a problem and patients are uncertain about correct technique. Nasal irrigation can be time-consuming and difficult for patients to use. Secondary care consultations can appear rushed, and patients would like specialists to take a more 'holistic' approach to their management. Surgery is often considered a temporary solution, appropriate when medical options have been explored.
Patients are frustrated with the management of their CRS, and poor communication can result in delays in receiving appropriate treatment and timely referral. Patients seek better understanding of their condition and guidance to support treatments decisions in light of uncertainties around the different medical and surgical options. Better coordinated care between general practice and specialist settings and consistency of advice has the potential to increase patient satisfaction and improve outcomes.
探索慢性鼻-鼻窦炎（CRS）患者在初级和二级保健中的当前管理的观点和看法。
作为 MACRO 项目（定义成人慢性鼻-鼻窦炎的最佳管理）的一部分，采用半结构式定性电话访谈。
英国初级保健和二级保健耳鼻喉科门诊。
25 名患者同意进行深入的电话访谈。使用 NVivo 软件管理转录录音，并使用归纳主题分析进行分析。
CRS 对患者的生活质量有重大影响，影响他们有效工作、社交互动和日常生活的能力。当症状变得难以控制时，患者会寻求帮助，但由于难以预约以及缺乏连续性护理，他们可能会对初级保健系统感到沮丧。患者认为全科医生可能对 CRS 症状不屑一顾，当他们就诊时，患者通常会优先考虑其他问题。卫生系统障碍和沟通不畅会导致延迟获得适当的治疗和转诊。鼻内类固醇的依从性是一个问题，患者不确定正确的使用技术。鼻腔冲洗对患者来说可能既耗时又困难。二级保健咨询可能显得仓促，患者希望专家在管理上采取更“全面”的方法。手术通常被认为是一种临时解决方案，在探索了药物治疗方案后才考虑手术。
患者对 CRS 的管理感到沮丧，沟通不畅会导致延迟接受适当的治疗和及时转诊。患者寻求更好地了解自己的病情，并在不确定不同药物和手术选择的情况下获得治疗决策的指导。在初级保健和专科治疗之间更好地协调护理并保持一致性的建议，有可能提高患者满意度并改善治疗结果。
