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Differences between rural and urban primary care practices in asthma and allergic rhinitis control: the Greek
Eirini Lambraki1, Izolde Bouloukaki1, Katerina Margetaki1
1Health Planning Unit, Department of Social Medicine, School of Medicine, University of Crete, Crete, Greece.
Introduction:
Limited data exist on allergic rhinitis and asthma control in rural primary care. Therefore, the aim of our study was to assess asthma and comorbid allergic rhinitis control in patients attending primary care in both urban and rural settings in Greece. Additionally, we aimed to identify potential factors associated with the control of asthma and comorbid allergic rhinitis.
Methods:
In this cross-sectional study, patients with asthma and comorbid allergic rhinitis completed questionnaires assessing demographic, co-morbidities and treatment status. Symptom control was evaluated by the Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ) and Control of Allergic Rhinitis/Asthma Test (CARAT). Multivariate logistic regression analysis was applied to identify associated factors of asthma and comorbid allergic rhinitis control after adjusting for age, gender, smoking status and comorbidities.
Results:
Out of 121 subjects with asthma and comorbid allergic rhinitis 75 (62%) resided in rural areas. A significant percentage of participants reported suboptimal asthma control using the ACT (54%) and ACQ (67%). Moreover, 88% of participants had not-well-controlled asthma and comorbid allergic rhinitis based on CARAT. Females (odds ratio (OR)=4.1, 95% confidence interval (CI) 0.8-19.9, p=0.043) and patients living in rural areas (OR=3.8, 95%CI 1.34-10.5, p=0.010) were more likely to report well-controlled asthma and allergic rhinitis based on CARAT score (>24). Patients reporting intranasal steroid use (OR=3.6, 95%CI 1.1-121, p=0.035) were more likely to have well-controlled asthma based on ACT score. Analysis also indicated a trend towards significance for the association between short-acting beta-agonist use and not-well-controlled asthma based on the ACT (score≤19) (OR=5, 95%CI 0.9-10, p=0.066) and partially and not-well-controlled asthma based on the ACQ (score>0.75) (OR=5, 95%CI 0.9-10, p=0.066).
Conclusion:
Our results suggest that asthma and allergic rhinitis control remain suboptimal in a large proportion of patients in primary care. Area of residence, female gender and medications emerged as significant associated factors that must be taken into account in order to effectively improve asthma and comorbid allergic rhinitis outcomes.
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