Allergic-rhinitis related knowledge, diagnosis, and treatment among general practitioners in Chaoyang District, Beijing

Background Allergic rhinitis (AR) is a highly prevalent chronic non-communicable disease. The research on the understanding and treatment of AR in China is mainly conducted by otorhinolaryngology specialists, but rarely by general practitioners (GPs). And recommendations on the diagnosis and treatment of AR in primary care are also insufficient. Objective To explore the knowledge of AR and diagnosis and treatment capacities related to AR in GPs. Methods By using simple random sampling, 432 GPs from 21 community health centers of Chaoyang District of Beijing were chosen between August and September 2020. The survey questionnaire was developed based on the Guidelines for the Diagnosis and Treatment of Allergic Rhinitis (Tianjin, 2015) (China 2015 AR Guidelines) and Allergic Rhinitis and Its Impact on Asthma (ARIA) Guidelines:2010 Revision, and its 2016 annual revision following expert consultation and a pre-survey. The questionnaire encompassed basic information, understanding to AR, diagnostic and therapeutic behaviors, training, and support needs regarding AR of GPs. Results There were 383 out of 432 total distributed questionnaires returned, with a response rate of 88.7%. Only 0.8% (3/383) of the GPs correctly responded to all of the questions on typical AR symptoms, diagnosis, treatment principle, first-line drug categories, and regimens suggested by guidelines. 32.4% (124/383) of the GPs reported that they knew Guidelines for AR, including China 2015 AR Guidelines and ARIA Guidelines, their sources of knowledge were from online continuing education platform, such as www.haoyisheng.com, www.dxy.cn and social media such as WeChat. When treating each patient with a respiratory disease, the percentage of GPs differentiating AR from other conditions, providing recommendations on environmental control, suggesting nasal rinsing, recommending other treatments instead of immunotherapy, and referring the patient to the specialty department without any treatment, was 59.8% (229/383), 37.1% (142/383), 17.8% (68/383), 49.4% (189/383), and 13.1% (50/383), respectively. In terms of pharmacological treatment, 17.5% (67/383) of GPs reported their facilities offered all four categories of first-line AR medications. As for AR-related training, 75.7% (366/383) of the GPs reported not having taken any AR-related training in 2019;and 91.7% (266/290) needed the training. And 95.6% (290/383) of the GPs reported AR should be treated standardized in the community. The Logistic regression analysis revealed that when encountering patients with respiratory symptoms, GPs with a master's degree or higher〔OR (95%CI) =2.790 (1.057, 7.366) 〕and a good understanding of AR-related health knowledge〔OR (95%CI) =3.537 (2.015, 6.209) 〕were more likely to distinguish AR from other illnesses, GPs with a good understanding of AR-related health knowledge〔OR (95%CI) =4.397 (0.534, 1.576) 〕were more likely to offer patients guidance on environmental control behaviors, GPs who were familiar with nasal irrigation procedures〔OR (95%CI) =6.592 (3.038, 14.306) 〕were more likely to recommend nasal irrigation, and GPs knowing about immunotherapy〔OR (95%CI) =1.881 (1.087, 3.254) 〕, accurately answering questions on the principles of treatment〔OR (95%CI) =128.330 (16.628, 990.402) 〕or their facilities providing some/all laboratory testing services〔OR (95%CI) =2.210 (1.299, 3.760) 〕were prone to recommend immunotherapy. Conclusion Despite insufficient knowledge of AR expertise and guidelines, and unsatisfied practice, GPs in Chaoyang District demonstrated proactive attitude towards continuing education and carrying out standardized AR treatment in primary care. As good understanding of AR-related knowledge and guidelines can promote quality of practice, relevant training for GPs should be strengthened, and AR-related guidelines applicable to primary care should be developed, which can provide support for the best practice of AR treatment in primary care.