Practice variations in the management of sinusitis

Objective: It has been shown that controlling inappropriate practice variat ions decreases cost, increases efficiency, and improves quality of health c are. The objective of this study was to identify practice variations in the management of acute sinusitis in primary care practice and to explore poss ible influential factors. Design: A cross-sectional study by mail survey was conducted. Subjects: Practicing primary care physicians in the province of Quebec were selected for the study. Methods: A questionnaire was sent to a random sample of 500 physician membe rs of the Quebec College of Physicians. Results: Three hundred and twenty-seven questionnaires were returned (total response rate = 65.4%), of which 53 were excluded. Two hundred and seventy -four completed surveys were then analyzed. Practice variations in the mana gement of acute sinusitis were observed with respect to diagnostic indicato rs, the use of diagnostic tools and imagery, prescription of therapeutic ag ents, factors influencing the choice of antimicrobial agents, and the indic ations for referral to a specialist. Factors affecting such variations incl uded age, gender, practice region (urban vs. rural), volume of practice, an d university affiliation. Conclusions: This survey confirms that confusion exists among primary care physicians about the recommended management of acute sinusitis, despite the recent advent of a multitude of clinical practice guidelines. These variat ions highlight the need for further research to clarify these issues, as we ll as better methods and more specific objectives for continuing medical ed ucation.