Regional and specialty variations in the treatment of chronic rhinosinusitis

To identify regional and specialty differences in the medical treatment of chronic rhinosinusitis (CRS).

Cross-sectional analysis of a national database.

Ambulatory visits for CRS were extracted from the National Ambulatory Medical Care Survey (NAMCS) for years 2005 to 2006. Medication utilization associated with CRS (antibiotics, antihistamines, nasal steroids, and oral steroids) was tabulated for medication class and individual drug. Statistical analyses were conducted to determine variations in medication class and specific drug utilization by U.S. geographic region and physician specialty, specifically primary care physicians (PCP) versus otolaryngologists (ORL).

Among an estimated 36.2 ± 0.3 million visits for CRS (mean age, 36.8 ± 1.4 years; 60.1 ± 1.9% female), the ratio of PCP to ORL visits was 10:1. The percent of clinician visits with prescriptions for antibiotics (47.3 ± 3.0% of overall visits), nasal steroids (10.8 ± 1.4%) and oral steroids (2.8 ± 0.7%) did not vary significantly by geographic region (P = .79,.66, and.34, respectively). Antihistamines were prescribed significantly more often in the South (15.3 ± 3.4% of visits vs. 11.3 ± 1.8% nationally, P = .04). PCPs were significantly more likely to prescribe antibiotics compared to ORLs (53.3 ± 2.9% vs. 27.4 ± 4.2%, respectively, P < .001) and less likely to prescribe both nasal steroids (9.7 ± 1.5% vs. 17.5 ± 2.8%, P = .01) and oral steroids (2.3 ± 0.7% vs. 6.6 ± 2.0%, P = .01). Significant differences existed for specific drugs prescribed according to specialty.

There are significant variations in the outpatient medical treatment of CRS according to geography and specialty. This study highlights the need for evidence-based medical treatment protocols for CRS.