title: Adolescent seasonal allergic rhinitis and the impact of health-care professional training: cluster randomised controlled trial of a complex intervention in primary care.
abstract: BACKGROUND
  Seasonal allergic rhinitis is typically poorly managed, particularly in adolescents, in whom it is responsible for considerable morbidity. Our previous work has demonstrated that if poorly controlled this can impair educational performance.
  
  
  OBJECTIVE
  The primary aim of this trial was to assess the impact of a primary care-based professional training intervention on clinical outcomes in adolescents with seasonal allergic rhinitis.
  
  
  METHODS
  Cluster trial in which UK general practice staff were randomised to a short, intensive workshop on the evidence-based management of seasonal allergic rhinitis. The primary outcome measure was the change in the validated Rhinoconjunctivitis Quality of Life Questionnaire with Standardized Activities (RQLQ(S)) score between baseline and 6 weeks post intervention (minimal clinically important difference=0.5). Secondary outcome measures of interest included health-care professionals' knowledge and confidence in managing seasonal allergic rhinitis, number of seasonal allergic rhinitis-related consultations, relevant treatments prescribed and symptom scores.
  
  
  RESULTS
  Thirty-eight general practices were randomised (20 in the intervention arm) and 246 patients (50.2% males, mean age 15 years) were included in the primary outcome analysis. Health-care professionals' knowledge and confidence of the clinical management of seasonal allergic rhinitis improved. This did not, however, result in clinically or statistically significant improvements in RQLQ(S): -0.15, (95% confidence interval, -0.5 to +0.2). There were no differences in consultation frequency, treatments issued for seasonal allergic rhinitis or symptom scores.
  
  
  CONCLUSIONS
  Although associated with increases in professionals' self-assessed confidence and understanding of seasonal allergic rhinitis management, this intensive training workshop did not translate into improvements in adolescents' disease-specific quality of life or a reduction in rhinitis symptoms.
authors.affiliation: Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
authors.forename: Victoria S
authors.initials: VS
authors.lastname: Hammersley
authors.affiliation: Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
authors.forename: Rob A
authors.initials: RA
authors.lastname: Elton
authors.affiliation: Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.
authors.forename: Samantha
authors.initials: S
authors.lastname: Walker
authors.affiliation: School of Molecular and Clinical Medicine, The University of Edinburgh, Western General Hospital, Edinburgh, UK.
authors.forename: Christian H
authors.initials: CH
authors.lastname: Hansen
authors.affiliation: 1] Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK [2] Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D004493:Education; D006801:Humans; D008297:Male; D058007:Physicians, Primary Care / Q000193:education*; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D011787:Quality of Health Care; D011788:Quality of Life; D006255:Rhinitis, Allergic, Seasonal / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome