Practice variations in the management of sinusitis.
OBJECTIVE
It has been shown that controlling inappropriate practice variations decreases cost, increases efficiency, and improves quality of health care. The objective of this study was to identify practice variations in the management of acute sinusitis in primary care practice and to explore possible influential factors.


METHODS
A cross-sectional study by mail survey was conducted.


METHODS
Practicing primary care physicians in the province of Quebec were selected for the study.


METHODS
A questionnaire was sent to a random sample of 500 physician members of the Quebec College of Physicians.


RESULTS
Three hundred and twenty-seven questionnaires were returned (total response rate = 65.4%), of which 53 were excluded. Two hundred and seventy-four completed surveys were then analyzed. Practice variations in the management of acute sinusitis were observed with respect to diagnostic indicators, the use of diagnostic tools and imagery, prescription of therapeutic agents, factors influencing the choice of antimicrobial agents, and the indications for referral to a specialist. Factors affecting such variations included age, gender, practice region (urban vs. rural), volume of practice, and university affiliation.


CONCLUSIONS
This survey confirms that confusion exists among primary care physicians about the recommended management of acute sinusitis, despite the recent advent of a multitude of clinical practice guidelines. These variations highlight the need for further research to clarify these issues, as well as better methods and more specific objectives for continuing medical education.
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Department of Otolaryngology, Centre Universitaire de Santé de l'Estrie, Fleurimont, Quebec.
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D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002170:Canada; D003430:Cross-Sectional Studies; D003710:Demography; D019937:Diagnostic Techniques and Procedures / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D017408:Guidelines as Topic; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D011320:Primary Health Care; D011787:Quality of Health Care; D012852:Sinusitis / Q000175:diagnosis* / Q000191:economics / Q000628:therapy*; D011795:Surveys and Questionnaires
D000900:Anti-Bacterial Agents