Prevention of perennial allergic rhinitis in the conception of coordinated healthcare in Poland.

Abstract

Introduction From the environmental-medicine and public-health Primary prevention is intended to prevent the development of diseases, secondary prevention aims to limit disease progression, and tertiary prevention involves reducing disease-associated symptoms. The purpose of this study was to assess the use of selected forms of secondary prevention by patients diagnosed with perennial allergic rhinitis. Moreover, this paper presents the ways in which the adopted organizational solutions could be utilized as part of coordinated healthcare to benefit patients with perennial allergies. Material and methods The study population comprised 18,617 respondents, 4,783 of whom (including patients allergic to Dermatophagoides pteronyssinus and Dermatophagoides farinae) were qualified to undergo a medical examination.The study used ECRHS and ISAAC questionnaires adapted for Europe. Results Nearly 20% of patients diagnosed with chronic allergic rhinitis used preventive measures against house dust mites; this is in contrast with 13% of the control group (p=1.358e-07). The secondary preventive measures used most commonly in the study group were, in descending order of frequency, mattress protectors and anti-dust-mite spray. Undertaking preventive measures was most common among study participants with a higher education and residents of large cities. Conclusions The proportion of patients diagnosed with a dust-mite allergy who undertook preventive measures against perennial allergic rhinitis was relatively low. Building, maintaining, and continual strengthening the doctors’ relationship with chronic allergy patients may shift the nature of healthcare services more towards preventive measures, for the implementation of which the patient will be coresponsible under the coordinated healthcare system. Powered by TCPDF (www.tcpdf.org) P ep ri t Prevention of perennial allergic rhinitis in the conception of coordinated healthcare in Poland. Introduction From the environmental-medicine and public-health perspective allergies constitute a significant problem. 1-8 The highly prevalent allergic rhinitis (AR), defined as “a clinically overt nasal disorder, which develops as a response to allergen exposure and takes the form of IgE-mediated inflammation of the nasal mucosa” , results in a lower quality of life, contributes to sleep disturbances, and lowers productivity at work and at school. The conditions which commonly accompany AR (such as conjunctivitis, otitis, sinusitis, or bronchial asthma) generate additional healthcare costs (including direct, indirect, and nonmeasurable costs). 1,10 The data above indicate a definite need to implement systemic solutions, such as an integrated healthcare system, in order to improve the quality of care at all levels of interaction with allergic patients. Coordinated healthcare should put a particular emphasis on preventive rather than corrective measures as the strategy of care designated for patients with lifestyle diseases. The purpose of our study was to assess the proportion of patients diagnosed with perennial allergic rhinitis (PAR) who could benefit from the solutions adopted in the chain of services offered by coordinated healthcare. According to the definition of the European Office for Integrated Health Care, which is part of the World Health Organization (WHO), coordinated care “is the concept of services related to the diagnosis, treatment, care, rehabilitation and promotion of health in the field of financial resources, implementation and organization of health services and management . For the Polish Association of Managed Care the Coordinated Health Protection (CHP) means organized activities of system participants aimed at achieving high cost effectiveness of services, quality of medical care and continuity of patient service. 11 The recently implemented concept of a hospital network is intended to help ensure the provision of healthcare services and improve the quality, safety and accessibility of highly specialized healthcare. This is being implemented by adopting and meeting transparent criteria (including establishing the cost of, and pricing, health services as well as setting the guidelines for cost accounting by the Agency for Health Technology Assessment and Tariffs (AOTMiT) based on healthcare-need maps. rep rin t Material and methods This study was conducted in two stages: stage I – questionnaire-based survey (18,617 respondents) conducted via ComputerAssisted Personal Interviewing (CAPI) with the use of personal digital assistant (PDA); stage II – complementary examination (4,783 patients) of a subgroup of stage I respondents who underwent a medical examination (Table 1). This subgroup was selected randomly, based on their Polish citizen identification numbers (PESEL numbers) being drawn randomly by the Ministry of Interior and Administration. The study was part of research project No. 6 PO5 2005 C/06572 Implementation of the system for the prevention and early detection of allergies in Poland (Epidemiology of Allergic Diseases in Poland, ECAP) commissioned by the Minister of Health and was a continuation of international studies European Community Respiratory Health Survey II (ECRHS II) 12 and International Study of Asthma and Allergies in Childhood (ISAAC) 13 adapted for Central and Eastern Europe. The cross-sectional study was conducted in a population of Polish respondents, who were residents of one of eight metropolitan areas (Gdansk, Wroclaw, Poznan, Katowice, Krakow, Lublin, Bialystok, Warszawa) or a rural area (Zamosc and Krasnystaw counties). For the purpose of analysis, study results were stratified by respondent age (6–7 years, 13–14 years, adults) and clinical diagnosis (AR, seasonal AR [SAR], and PAR). According to the diagnostic criteria for AR included in Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines , nearly 23% of all respondents had AR. Out of all those diagnosed with AR, 14% had SAR and 15% had PAR. The study population comprised mostly females and metropolitan-area residents. Among the all-year allergens assessed in skinprick tests, the one predominantly responsible for patients’ symptoms was Dermatophagoides pteronyssinus especially in comparison with Dermatophagoides farinae (Figure 1). Interestingly, positive skin-prick test results were most commonly due to house dust mites rather than grass or tree pollens. As dictated by the stages of the study, data analyses were done separately for certain items from the questionnaires: the responses given at the first and second stages of the study that had been verified by medical history and examination, including skin-prick testing (Allergopharma) (birch; grasses/cereals; wormwood; Dermatophagoides pteronyssinus and Dermatophagoides farinae; molds [group I]: Botrytis cinerea, Cladosporium herbarum, Alternaria tenuis, Curvularia lunata, Pr pri t Fusarium moniliforme, Helminthosporium; and molds [group II]: Aspergillus fumigatus, Mucor mucedo, Penicillium notatum, Pullularia pullulans, Rhizopus nigricans, Serpula lacrymans; dog; cat; hazel; alder; rye; ribleaf; Cladosporium herbarum; Alternaria tenuis) with negative and positive (histamine) controls; spirometry, and peak nasal inspiratory flow (PNIF) test. This study had been approved by the Ethics Committee/Institutional Review Board at Medical University of Warsaw (KB/206/2005) and the Inspector General for the Protection of Personal Data. Statistical analysis was performed with the use of the prop.test function (i.e. a test for equality of proportions) and contingency tables. The odds ratios (OR) for the use of various prevention measures in individual groups of patients were calculated based on a logistic regression model. The basic catalysts as the mechanisms of change required for the introduction of coordinated health protection are: 1. ENSURING EXTERNAL CONDITIONS political will and appropriate political and executive decisions at the level of the Ministry of Health (MH), and further contracting them by the National Health Fund (NHF). 2. MONEY grants from the European Union (EU) and loans from the World Bank (WB) and others. 3. SUPPORT AND KNOWLEDGE which is created / shaped by giving appropriate program directions to the Ministry of Health (MH), voivodships, poviats and relevant technical guidelines for restructuring and other projects support from scientists, the World Bank, and others. Coordinated patient care as a disease management has become now one of the main topics of discussion in the Polish health care system. The experience drawn from international practices helped to create for eg. a basis for the process of coordinated care in oncology in Poland. 14 The pilot Primary Health Care PLUS model has been testing in Poland since July 2018 and is in line with the Strategy for the development of primary health care and applicable in the field of primary health care developed by the Ministry of Health. The scope of the Primary Health Care (PHC) includes: first-line care and triage; diagnostic services; therapeutic services together with health check; preventive services and health promotion; and also over mother and child and reproductive health. There is also a trend of expanding the scope of tasks in primary care, with greater involvement in screening, prevention and health promotion. 15 Pr ep rin t There is also extensive research showing the various elements and definitions of coordinated care and revealing different perspectives that affect the design and shape of this process. Coordinated care is not a result but an important factor in improving the quality of health care. 16 Therefore, coordinated care is also an important factor in improving the quality and efficiency of healthcare, for the chronically ill allergologically patient in Poland. We could reach this through organizational restructuring and the implementation of a new model of paying service providers. The activities undertaken are to ensure good management