Otolaryngologist adherence to the AAO-HNSF Allergic Rhinitis Clinical
Adam Honeybrook, MBBS, Matthew Ellison, MD, Liana Puscas, MD and Eileen Raynor, MD
Background: In February 2015, the American Academy
of Otolaryngology–Head and Neck Surgery (AAO-HNSF)
published the Allergic Rhinitis Clinical Practice Guideline
(AR-CPG). The objective of this study was to assess oto-
laryngologists’ perception of the accuracy and adherence
to the AR-CPG.
Methods: A survey was distributed to fellows of the
American Academy of Otolaryngic Allergy and members of
the American Academy of Otolaryngology–Head and Neck
Surgery Foundation. A total of 601 otolaryngologists re-
sponded. The survey evaluated otolaryngologists’ demo-
graphic data, perception of the accuracy of the guideline,
and adherence to the guideline action statements.
Results: The majority of respondents were actively practic-
ing (544 [90.5%]), for a duration of 11–30 years (308 [51.2%]),
in a private practice seing (387 [64.4%]). The cohort was
largely fellowship trained (348 [57.9%]) and had reviewed
the guideline (428 [71.2%]). Most respondents perceived
the guideline as being correct “a great deal” (295 [69.7%])
and deviated from the guideline “only a lile” (302 [71.6%]).
High rates of adherence to the strong guideline recom-
mendations were observed. Respondents “always/most of
the time” recommended intranasal steroids (581 [97.6%]),
and oral antihistamines (439 [74%]) as primary therapy.
Otolaryngologists in practice for longer were more likely
to deviate from the guideline recommendations by ob-
taining sinonasal imaging (p = 0.007) and recommending
oral leukotriene receptor antagonists as primary therapy
(p = 0.0001).
Conclusion: Overall perception of the correctness of and
adherence to the AR-CPG was high in this cohort. Targeted
education resources should be provided to otolaryngolo-
gists in practice for longer in eﬀorts to reduce harmful or
unnecessary variations in care.
2018 ARS-AAOA, LLC.
adherence; allergic rhinitis; allergy; clinical practice
How to Cite this Article:
Honeybrook A, Ellison M, Puscas L, Raynor E. Otolaryn-
gologist adherence to the AAO-HNSF Allergic Rhinitis
Clinical Practice Guideline. Int Forum Allergy Rhinol.
ncreasingly, clinicians are barraged with a vast volume of
evidence of uncertain value. Hence, critically appraised
and synthesized scientiﬁc evidence has become fundamen-
tal to clinical practice.
Clinical practice guidelines (CPGs)
are statements that include recommendations intended to
optimize patient care and are created by a systematic review
of evidence, which includes assessment of the beneﬁts and
Division of Head and Neck Surgery & Communication Sciences, Duke
University Health System, Durham, NC
Correspondence to: Adam Honeybrook, MBBS, Division of Head and Neck
Surgery & Communication Sciences, Duke University Health System, 40
Medicine Circle, Durham, NC 27710; e-mail: firstname.lastname@example.org
Potential conﬂict of interest: None provided.
Previously presented at the AAOA Annual Meeting on September 18, 2016,
in San Diego, CA, and September 18, 2017, in Chicago, IL. Awarded second
place by the AAOA Board of Directors at the 2017 Annual Meeting.
Received: 6 June 2017; Revised: 21 December 2017; Accepted:
12 January 2018
View this article online at wileyonlinelibrary.com.
harms of alternative care options.
These guidelines are
intended to produce optimal health outcomes for patients,
to minimize harm, and to reduce inappropriate variations
in clinical care.
CPGs are not intended to supersede pro-
fessional judgment but rather may be viewed as a relative
constraint on individual clinician discretion in a particular
Essentially, CPGs represent the best
judgment of a team of experienced clinicians and method-
ologists addressing the scientiﬁc evidence on a particular
CPGs have limited impact on clinical practice un-
less they are successfully integrated into clinical settings.
As we shift to increase the implementation of evidence into
everyday clinical practice, the importance of understanding
the perception of and adherence to evidence-based clinical
practice guidelines is vital for improving effectiveness, qual-
ity, and safety of patient care.
The literature shows that otolaryngologists have vari-
able rates of compliance with CPGs. In 2012, Aarts
741 International Forum of Allergy & Rhinology, Vol. 8, No. 6, June 2018