Wubs, M. (Marian) (2014) Testen van de uitvoerbaarheid van de allergiedienst in de eerste lijn. Ontwikkeling van een geautomatiseerd systeem ter ondersteuning van de allergiediagnostiek en beleidsvoering in de eerste lijn. thesis, Medicine.
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Abstract
Introduction: An allergy is a reaction of the immune system to foreign substances (allergens). The most common type of allergy are the atopic diseases, such as allergic rhinitis, asthma, atopic dermatitis and food allergy. This type of allergy is IgE mediated, meaning that specific antibodies are produced (sIgE) against specific allergens. The prevalence of allergies has increased in recent decades. 39% of children and 30% of adults have been diagnosed with one or more atopic diseases. Because of this increase GPs more often see patients with allergic symptoms. However, GPs appear to have troubles with the diagnosis and management. In particular, the interpretation of the specific IgE levels in blood and detection and treatment of food allergy appears to be difficult. To assist GPs in the diagnosis and management an allergy service has been developed as part of the IDEAL project (In vitro Diagnostiek en Eerstelijns Allergie Leidraad). This allergy service formulates an advice with diagnoses and management based on a history questionnaire and sIgE result. This advice goes to the GP. The allergy service is currently under development. Aim of the study: The primary objective of this study is to test the feasibility of the allergy service among GPs. In addition to the primary goal a rough estimate is made of the effects of the allergy service in primary care. At last quality of life in this patient group is measured. If the feasibility has been proved, in the future a project could be started to evaluate the costs against the effects of the allergy service. Population and Methods: This study is a RCT study. 75 GPs are divided into two groups: the advice group and the control group. When the GP requested a sIgE test he gave the patient a questionnaire. The allergy service used a pattern system to create an advice letter. This advice letter was checked by an allergy specialist. Afterwards the letter was sent to the GPs in the advice group only. GPs in both groups filled in a short questionnaire about their diagnosis and management for their patient, before and after they received the sIgE result (with or without advice). The GPs in the advice group also gave their opinion about the advice. Results: The allergy service formulated an advice letter for 20 patients out of the 21 who sent back their questionnaire. In 100% of the cases, the allergy service was able to send an advice letter within 10 days (mean 3.0 days, SD 2.6). The specialist had on average two comments per letter, the major part of these were changes in management steps. 77.8% of the GPs followed the advice mainly. Diagnoses in the advice group were more consistent with the diagnoses of the allergy service than the diagnoses in the control group. Conclusion: The allergy service can be regarded as feasible. It is not possible to draw conclusions about the effects of the allergy service, because of the small number. There is a trend that GPs with advice make more appropriate diagnoses then GPs without an advice. Thereby fewer diagnoses were overlooked. Larger numbers are needed to say more about the effect of the allergy service. After that the project could be started to evaluate the costs against effects of the allergy service.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Flokstra– de Blok, Dr. B.M.J. and Molen, Prof. dr. T. van der |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:47 |
| Last Modified: | 25 Jun 2020 10:47 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/854 |
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