A North London Pilot Survey to Assess the Need for a Medical Device in Diagnosing Chronic Rhinosinusitis in Primary Care

Introduction and Objectives: A pilot study to evaluate the need for a medical device in primary care to help diagnose chronic rhinosinusitis (CRS) from other causes of nasal obstruction. Significant delays in the diagnosis and treatment of CRS in UK secondary care cause long-term detrimental effects on the patient.
Method: A questionnaire-based survey was conducted at a General Practitioner (GP) General Update course in November 2017 attended by 134 GPs from North London, our major referral base. 105 questionnaires were completed: 83 in person and 22 subsequently online. Qualitative interviews were conducted with a North London focus group in order to construct the questionnaire and thermatic analysis performed.

Results: The response rate was 78% (105/134). 56% reported diagnosing CRS as moderately difficult. 95% would invest in a medical device to help diagnose CRS from other causes of nasal obstruction. Most are unaware of the 2012 EPOS CRS guidelines for diagnosis (84%) and instead use local guidelines. Over two-thirds (69%) refer fewer than 20% of patients to secondary care and most (80%) do so within 6 months. The recurring theme following thermatic analysis was the need for a nurse-led nasal blockage clinic in primary care in order to maximise adoption of such a medical device. This would better utilise GP time and improve patient satisfaction.

Conclusion: A medical device facilitating diagnosis of CRS could play an important role in primary care, in a nurse-led clinic setting. This would save valuable GP resources and reduce unnecessary referrals to secondary care. This study demonstrates that the majority of GPs refer their medical refractory CRS patients to secondary care in a timely fashion. However it does not explain the current delay in secondary care treatment in the UK and instead this maybe more related to patient dissatisfaction and non-compliance in their nasal blockage journey.

Keywords: Nasal Obstruction, Diagnosis, Assessment, General Practice.