A nationwide survey of otolaryngologists' compliance with Chinese guidelines for diagnosis and treatment of allergic rhinitis

Lei Cheng; Hua-Bin Li; Ya-Mei Zhang; Chang-Qing Zhao; Fu-Quan Chen; Li Shi; Na Li; Bei-Bei Yang; Yong Li; Hui-Jun Li; Sheng-Nan Ye; Ze-Zhang Tao; Ge-Hua Zhang; Rui Xu; Qin-Tai Yang; Dong-Dong Zhu; Feng Liu; Hua Zhang; Yu-Cheng Yang; Peng Lin; Chang-Yu Qiu; Bing Zhou; Rhinology Group of the Chinese Society of Otorhinolaryngology-Head and Neck Surgery

doi:10.1016/j.waojou.2021.100552

A nationwide survey of otolaryngologists' compliance with Chinese guidelines for diagnosis and treatment of allergic rhinitis

World Allergy Organ J. 2021 Jun 7;14(6):100552. doi: 10.1016/j.waojou.2021.100552. eCollection 2021 Jun.

Authors

Lei Cheng^{1

2}, Hua-Bin Li³, Ya-Mei Zhang⁴, Chang-Qing Zhao⁵, Fu-Quan Chen⁶, Li Shi⁷, Na Li⁸, Bei-Bei Yang⁹, Yong Li¹⁰, Hui-Jun Li¹¹, Sheng-Nan Ye¹², Ze-Zhang Tao¹³, Ge-Hua Zhang¹⁴, Rui Xu¹⁵, Qin-Tai Yang^{14

16}, Dong-Dong Zhu¹⁷, Feng Liu¹⁸, Hua Zhang¹⁹, Yu-Cheng Yang²⁰, Peng Lin²¹, Chang-Yu Qiu¹, Bing Zhou²²; Rhinology Group of the Chinese Society of Otorhinolaryngology-Head and Neck Surgery

Affiliations

¹ Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China.
² International Centre for Allergy Research, Nanjing Medical University, Nanjing, China.
³ Department of Otolaryngology-Head Neck Surgery, Affiliated Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China.
⁴ Department of Otolaryngology-Head and Neck Surgery, Beijing Children's Hospital, Capital Medical University, Beijing, China.
⁵ Department of Otolaryngology-Head and Neck Surgery, Second Hospital of Shanxi Medical University, Taiyuan, China.
⁶ Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Air Force Medical University of PLA, Xi'an, China.
⁷ Department of Nasal Allergy, Shandong Provincial ENT Hospital, Shandong University, Jinan, China.
⁸ Department of Otorhinolaryngology, The Affiliated Hospital of Qingdao University, Qingdao, China.
⁹ Department of Otorhinolaryngology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
¹⁰ Department of Otolaryngology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
¹¹ Department of Otorhinolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
¹² Department of Otolaryngology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China.
¹³ Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital, Wuhan University, Wuhan, China.
¹⁴ Department of Otolaryngology-Head Neck Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
¹⁵ Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
¹⁶ Department of Allergy, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
¹⁷ Department of Otorhinolaryngology-Head and Neck Surgery, China-Japan Union Hospital, Jilin University, Changchun, China.
¹⁸ Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China.
¹⁹ Department of Otolaryngology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
²⁰ Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
²¹ Department of Otorhinolaryngology-Head and Neck Surgery, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin, China.
²² Department of Otolaryngology-Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China.

Abstract

Background: A higher compliance with clinical guidelines helps improve treatment outcomes. But the clinical practice of otolaryngologists is not always consistent with guidelines.

Objective: To describe otolaryngologists' compliance with guidelines about allergic rhinitis (AR) management and identify factors responsible for the discordance between clinical practice and guideline recommendations in China.

Methods: A cross-sectional nationwide survey was designed and conducted via an online platform. Recruitment was done by emailing otolaryngologists registered in the Chinese Society of Otorhinolaryngology-Head and Neck Surgery or by inviting otolaryngologists to scan a Quick Respond (QR) code that linked to the questionnaire at various academic meetings.

Results: A total of 2142 otolaryngologists were eligible and completed the survey. Of them, 64.7% had over 10 years work experience and 97.4% had a bachelor's degree or higher. About 18.3% of the participants strictly copied the guideline in clinical practice, while 73.7% used the guideline that had been adjusted according to their clinical experience. Otolaryngologists were most concerned about the efficacy, safety, and minimum age of AR medications, and least concerned about patient preferences. Regarding the use of intranasal steroids (INS), leukotriene receptor antagonists (LTRA), and H1-antihistamines, 86.8%, 55.7% and 51.2% of otolaryngologists complied with the guideline recommendations, respectively. Educational background was a factor affecting the compliance with guidelines and acceptance of INS.

Conclusion: A vast majority of Chinese otolaryngologists complied with the current Chinese AR guidelines. A difference still existed between the otolaryngologists' real-world and guideline-recommended management. The otolaryngologists should pay more attention to patient preferences. A higher education could improve otolaryngologists' adherence to the guidelines.

Keywords: Adherence; Allergic rhinitis; Clinical practice guidelines; Otolaryngologists; Perception; Survey.