title: Nasal spray adherence after sinus surgery: problems and predictors.
abstract: OBJECTIVE
  To assess patient adherence to nasal spray regimens after endoscopic sinus surgery (ESS) and to study factors that predict adherence.
  
  
  METHODS
  A three-arm, randomized, blinded, controlled trial was conducted at a tertiary care academic hospital, studied via a prospective longitudinal survey, of 60 consecutive chronic rhinosinusitis patients managed with ESS and started on one of three postoperative nasal spray regimens. Structured telephone interviews were conducted after surgery over a 12-month period using a validated questionnaire that assessed both spray adherence and barriers to adherence. Patient demographics, time post-ESS, preoperative Sino-Nasal Outcome Test (SNOT) scores, Lund-Mackay scores, adherence risk factors, and polyp grades were used as covariates with logistic regression.
  
  
  RESULTS
  Overall, 57.4% of patients were nonadherent. Logistic regression showed that preoperative SNOT scores (p = .018, 95% CI = 0.84-0.98), time post-ESS (p = .016, 95% CI = 1.02-1.22), and the presence of an adherence risk factor (p = .03, 95% CI = 1.18-26.99) significantly predicted whether a patient was adherent and correctly classified 70.4% of all patients. Age, gender, and nasal spray regimen did not predict adherence (p > .05).
  
  
  CONCLUSIONS
  The majority of patients were nonadherent to post-ESS nasal sprays, irrespective of which nasal spray regimen they were on. Preoperative SNOT scores, time post-ESS, and the presence of an adherence risk factor predicted adherence. With this knowledge, otolaryngologists can selectively employ strategies to improve adherence in high-risk patients and possibly improve ESS outcomes.
authors.affiliation: Department of Otolaryngology–Head and Neck Surgery, University of Western Ontario, London, ON. Shahin.Nabi@uwo.ca
authors.forename: Shahin
authors.initials: S
authors.lastname: Nabi
authors.forename: Brian W
authors.initials: BW
authors.lastname: Rotenberg
authors.forename: Iva
authors.initials: I
authors.lastname: Vukin
authors.forename: Keith
authors.initials: K
authors.lastname: Payton
authors.forename: Yves
authors.initials: Y
authors.lastname: Bureau
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D059085:Nasal Sprays; D013517:Otorhinolaryngologic Surgical Procedures; D010256:Paranasal Sinuses / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D011379:Prognosis; D012220:Rhinitis / Q000150:complications / Q000601:surgery*; D012852:Sinusitis / Q000150:complications / Q000601:surgery*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D059085:Nasal Sprays