Secondary Care

Chronic rhinosinusitis (CRS) is a prevalent inflammatory condition of the mucosa of the nose and paranasal sinuses, in the presence (CRSwNP) or absence (CRSsNP) of nasal polyps. Prevalence rates are approximately 10% in the UK and data from the Clinical Practice Research Datalink estimate that 1% of UK adults receive treatment annually in primary care.

Patients with CRS typically report symptoms of nasal congestion, nasal discharge, facial pain/pressure and anosmia which can have a significant effect on health-relate quality of life. Research has found the impact of CRS to be equal to or greater than other chronic diseases such as congestive heart failure, angina and chronic obstructive pulmonary disease, and the extent of impact has been found to affect patient CRS treatment decisions.

Self-management techniques

Treatment for CRS may include self management techniques, topical and oral medical treatments and surgery. However, patient expectations and experiences of CRS management have yet to be fully explored. Preliminary qualitative research identify patients’ frustration with inadequate treatment and lack of coordinate care.

Hence, further work is require to better understand the patient pathway in terms of patient practitioner interactions, decision-making for treatments and indication for referral. There may also be differing views between healthcare professionals and patients regarding the severity and impact of sinus disease which needs exploring in light of its potential effect on the patient pathway.

CRS has a significant impact on patients’ quality of life, affecting their ability to work effectively; hence their social interactions and daily living. Patients seek help when symptoms become unmanageable; but can become frustrate with the primary care system with difficulties obtaining an appointment and with lack of continuity of care. GPs can be perceive as being dismissive of CRS symptoms and patients often prioritise other concerns when they consult.
This lack of acknowledgement and communication can result in delays in accessing appropriate treatment and referral. Adherence to intranasal steroids is a problem and patients are often uncertain about correct application. Nasal irrigation can be time-consuming and difficult for patients to use.

Patients would like specialists

Secondary care consultations can appear rush, and patients would like specialists to take a more ‘holistic’ approach, by considering CRS management in the wider context of the patients’ overall health and well-being. Surgery is often consider a temporary solution, appropriate when medical options have been explored.

In summary, our qualitative study identify that patients can become frustrate with the management of their CRS; also impact on quality of life is not always recognised. Better coordinate care between general practice and specialist settings; so with evidence base treatment options and a clear, integrate care pathway; so is need to optimise CRS patient management across both settings.

The MACRO program also include a qualitative study exploring primary and secondary care clinicians’ views of CRS management; which has recently publish. These two qualitative papers should ideally be consider in conjunction; also their findings have help inform the trial design in MACRO. Together with the trial findings, they will help to formulate; so new recommendations for the management of patients with CRS across primary and secondary care.