D Ryan1, R Gerth van Wijk2, E Angier3, M Kristiansen4, H Zaman5, A Sheikh1, V Cardona6, C Vidal7, A Warner8, I Agache9, S Arasi10,11, M Fernandez-Rivas12, S Halken13, M Jutel14, S Lau11, G Pajno10, O Pfaar15,16, G Roberts17,18,19, G Sturm20,21, E M Varga22, R Van Ree23, A Muraro24. 1. Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburgh, UK. 2. Allergy Section, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands. 3. GPwSI in Allergy, Department of Clinical Immunology and Allergy, Northern General Hospital, Sheffield, UK. 4. Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark. 5. Senior Lecturer in Pharmacy Practice, Faculty of Life Sciences, School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK. 6. Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain. 7. Allergy Department and Faculty of Medicine, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela University, Santigo, Spain. 8. Head of Clinical Services, Allergy UK, Planwell House, LEFA Business Park, Sidcup, Kent, UK. 9. Faculty of Medicine, Department of Allergy and Clinical Immunology, Transylvania University Brasov, Brasov, Romania. 10. Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy. 11. Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany. 12. Allergy Department, Hospital Clinico San Carlos, IdISSC, Madrid, Spain. 13. Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark. 14. Wroclaw Medical University, ALL-MED Medical Research Institute, Wrocław, Poland. 15. Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. 16. Center for Rhinology and Allergology, Wiesbaden, Germany. 17. The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport Isle of Wight, UK. 18. NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 19. Faculty of Medicine, University of Southampton, Southampton, UK. 20. Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria. 21. Outpatient Allergy Clinic Reumannplatz, Vienna, Austria. 22. Department of Paediatric and Adolescent Medicine, Respiratory and Allergic Disease Division, Medical University of Graz, Graz, Austria. 23. Departments of Experimental Immunology and of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 24. Department of Mother and Child Health, The Referral Centre for Food Allergy Diagnosis and Treatment Veneto Region, University of Padua, Padua, Italy.
Abstract
PURPOSE: The European Academy of Allergy and Clinical Immunology (EAACI) has produced Guidelines on Allergen Immunotherapy (AIT). We sought to gauge the preparedness of primary care to participate in the delivery of AIT in Europe. METHODS: We undertook a mixed-methods, situational analysis. This involved a purposeful literature search and two surveys: one to primary care clinicians and the other to a wider group of stakeholders across Europe. RESULTS: The 10 papers identified all pointed out gaps or deficiencies in allergy care provision in primary care. The surveys also highlighted similar concerns, particularly in relation to concerns about lack of knowledge, skills, infrastructural weaknesses, reimbursement policies and communication with specialists as barriers to evidence-based care. Almost all countries (92%) reported the availability of AIT. In spite of that, only 28% and 44% of the countries reported the availability of guidelines for primary care physicians and specialists, respectively. Agreed pathways between specialists and primary care physicians were reported as existing in 32%-48% of countries. Reimbursement appeared to be an important barrier as AIT was only fully reimbursed in 32% of countries. Additionally, 44% of respondents considered accessibility to AIT and 36% stating patient costs were barriers. CONCLUSIONS: Successful working with primary care providers is essential to scaling-up AIT provision in Europe, but to achieve this, the identified barriers must be overcome. Development of primary care interpretation of guidelines to aid patient selection, establishment of disease management pathways and collaboration with specialist groups are required as a matter of urgency.
PURPOSE: The European Academy of Allergy and Clinical Immunology (EAACI) has produced Guidelines on Allergen Immunotherapy (AIT). We sought to gauge the preparedness of primary care to participate in the delivery of AIT in Europe. METHODS: We undertook a mixed-methods, situational analysis. This involved a purposeful literature search and two surveys: one to primary care clinicians and the other to a wider group of stakeholders across Europe. RESULTS: The 10 papers identified all pointed out gaps or deficiencies in allergy care provision in primary care. The surveys also highlighted similar concerns, particularly in relation to concerns about lack of knowledge, skills, infrastructural weaknesses, reimbursement policies and communication with specialists as barriers to evidence-based care. Almost all countries (92%) reported the availability of AIT. In spite of that, only 28% and 44% of the countries reported the availability of guidelines for primary care physicians and specialists, respectively. Agreed pathways between specialists and primary care physicians were reported as existing in 32%-48% of countries. Reimbursement appeared to be an important barrier as AIT was only fully reimbursed in 32% of countries. Additionally, 44% of respondents considered accessibility to AIT and 36% stating patient costs were barriers. CONCLUSIONS: Successful working with primary care providers is essential to scaling-up AIT provision in Europe, but to achieve this, the identified barriers must be overcome. Development of primary care interpretation of guidelines to aid patient selection, establishment of disease management pathways and collaboration with specialist groups are required as a matter of urgency.
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Authors: P W Hellings; B Pugin; G Mariën; C Bachert; C Breynaert; D M Bullens; J L Ceuppens; G Clement; T Cox; D Ebo; P Gevaert; S Halewyck; V Hox; K Ladha; R Jacobs; P Rombaux; R Schrijvers; K Speleman; X Van der Brempt; L Van Gerven; O Vanderveken; B Verhaeghe; K Vierstraete; S Vlaminck; J-B Watelet; J Bousquet; S F Seys Journal: Clin Transl Allergy Date: 2019-02-04 Impact factor: 5.871
Authors: Bertine M J Flokstra-de Blok; Thecla M Brakel; Marian Wubs; Ben Skidmore; Janwillem W H Kocks; Joanne N G Oude Elberink; Marie-Louise A Schuttelaar; Jantina L van der Velde; Thys van der Molen; Anthony E J Dubois Journal: Clin Transl Allergy Date: 2018-05-29 Impact factor: 5.871
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