[Can we improve the therapeutic management of allergic rhinitis in primary care?].
OBJECTIVE
To evaluate improvement in therapeutic management of allergic rhinitis.


METHODS
Study of level of quality (longitudinal, prospective, intervention).


METHODS
Primary care.


METHODS
First evaluation (second quarter of 1995): 73 out of 305 patients were sampled (confidence 5%, accuracy 10%). Second evaluation (second quarter of 1996). Sample of 51 patients from a total of 210.


METHODS
Explicit criteria and standard procedure, based on consensus, for rhinitis treatment and an overall indicator of the general quality of rhinitis management were analysed. Criterion 1 (C1): correctly scaled treatment; criterion 2 (C2): initial treatment of choice with inhaled corticoids; criterion 3 (C3): correct use of oral corticoids or immunotherapy; criterion 4 (C4): coadjutant therapy according to predominant symptoms. Corrective measures: ongoing training and routine use of guide to practice.


METHODS
index of compliance with criteria, Chi squared and Fisher's Z tests of a tail to compare both evaluations.


RESULTS
First evaluation: index of compliance with C1 = 59% (CI +/- 11), C2 = 41% (CI +/- 11), C3 = 90% (CI +/- 6) and C4 = 83% (CI +/- 8). Criteria and summary indicator obtained better results in patients attended by allergists. Second evaluation with overall improvement: C1 = 68.6% (CI +/- 13), C2 = 57% (CI +/- 13), C3 = 94% (CI +/- 6), C4 = 98% (CI +/- 3). Significant differences for C4 and C2 (p < 0.05). Overall quality and quality of criteria improved for patients attended in our environment. The summary indicator went up from 35.6% to 57% (p = 0.019), with the quality levels (C1-C4) becoming the same as those of the patients with allergy attended and with significant differences in the first evaluation disappearing.


CONCLUSIONS
Ongoing training and routine use of guides to practice enables the therapeutic management of allergic rhinitis in primary care to be improved.
Menárguez Puche
J F
JF
Centro de Salud Virgen de la Consolación, Molina de Segura, Murcia. palcantaram@papps.org
Lorenzo Zapata
M D
MD
Sánchez López
M I
MI
Alcántara Muñoz
P A
PA
López Román
F J
FJ
Martínez Gonzálvez
A B
AB
D000465:Algorithms; D006801:Humans; D011320:Primary Health Care; D011446:Prospective Studies; D012221:Rhinitis, Allergic, Perennial / Q000628:therapy*; D006255:Rhinitis, Allergic, Seasonal / Q000628:therapy*