title: Development of an allergy management support system in primary care.
abstract: BACKGROUND
  Management of allergic patients in the population is becoming more difficult because of increases in both complexity and prevalence. Although general practitioners (GPs) are expected to play an important role in the care of allergic patients, they often feel ill-equipped for this task. Therefore, the aim of this study was to develop an allergy management support system (AMSS) for primary care.
  
  
  METHODS
  Through literature review, interviewing and testing in secondary and primary care patients, an allergy history questionnaire was constructed by allergists, dermatologists, GPs and researchers based on primary care and specialists' allergy guidelines and their clinical knowledge. Patterns of AMSS questionnaire responses and specific immunoglobulin E (sIgE)-test outcomes were used to identify diagnostic categories and develop corresponding management recommendations. Validity of the AMSS was investigated by comparing specialist (gold standard) and AMSS diagnostic categories.
  
  
  RESULTS
  The two-page patient-completed AMSS questionnaire consists of 12 (mainly) multiple choice questions on symptoms, triggers, severity and medication. Based on the AMSS questionnaires and sIgE-test outcome of 118 patients, approximately 150 diagnostic categories of allergic rhinitis, asthma, atopic dermatitis, anaphylaxis, food allergy, hymenoptera allergy and other allergies were identified, and the corresponding management recommendations were formulated. The agreement between the allergy specialists' assessments and the AMSS was 69.2% (CI 67.2-71.2).
  
  
  CONCLUSIONS
  Using a systematic approach, it was possible to develop an AMSS that allows for the formulation of diagnostic and management recommendations for GPs managing allergic patients. The AMSS thus holds promise for the improvement of the quality of primary care for this increasing group of patients.
authors.affiliation: Department of General Practice; GRIAC Research Institute.
authors.forename: Bertine Mj
authors.initials: BM
authors.lastname: Flokstra-de Blok
authors.affiliation: Department of General Practice; GRIAC Research Institute.
authors.forename: Thys
authors.initials: T
authors.lastname: van der Molen
authors.affiliation: Department of Dermatology.
authors.forename: Wianda A
authors.initials: WA
authors.lastname: Christoffers
authors.affiliation: Department of General Practice; GRIAC Research Institute.
authors.forename: Janwillem Wh
authors.initials: JW
authors.lastname: Kocks
authors.affiliation: Department of Allergology.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Oei
authors.affiliation: GRIAC Research Institute; Department of Allergology.
authors.forename: Joanne Ng
authors.initials: JN
authors.lastname: Oude Elberink
authors.affiliation: Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen.
authors.forename: Emmy M
authors.initials: EM
authors.lastname: Roerdink
authors.affiliation: Department of Dermatology.
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: Schuttelaar
authors.affiliation: Department of General Practice; GRIAC Research Institute.
authors.forename: Jantina L
authors.initials: JL
authors.lastname: van der Velde
authors.affiliation: Department of General Practice; Teaching Unit, Department of Social Psychology, University of Groningen, Groningen, The Netherlands.
authors.forename: Thecla M
authors.initials: TM
authors.lastname: Brakel
authors.affiliation: GRIAC Research Institute; Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen.
authors.forename: Anthony Ej
authors.initials: AE
authors.lastname: Dubois
keywords: allergy; development; diagnosis; management support system; primary care