Knowledge of chronic spontaneous urticaria management among Italian general practitioners: Baseline findings from the BRIDGE study

Abstract Introduction Patients with chronic spontaneous urticaria (CSU) often experience diagnostic delays and uncontrolled disease, highlighting the need to improve CSU care. The BRIDGE study, a hybrid type 1 effectiveness-implementation study, evaluated the effectiveness and feasibility of an urticaria care package (UCP) to increase patient-reported outcome (PRO) use in clinical practice and improve CSU care among general practitioners (GPs). Two surveys were conducted, 1 before and 1 after UCP implementation. This report focuses on pre-implementation data regarding the management and knowledge of CSU among GPs in Italy. Methods Eligible GPs were from Lombardy, an administrative region of Italy, who had been in clinical practice for 3–30 years and had access to electronic medical records. GPs completed a self-administered, web-based survey, prior to UCP implementation. Survey questions included the following topics: awareness and knowledge of CSU, use of CSU-specific PROs or other PROs, attitudes towards UCP adoption, implementation climate, and key factors influencing UCP adoption. The analysis included GPs who completed ≥1 item on the pre-implementation survey. Results The analysis included 95 GPs (mean age: 37.7 years; female: 50.5%; mean time practicing medicine: 10.1 years). On average over the previous 6 months, GPs managed 3.6 patients with suspected CSU, diagnosed 2.3 patients with CSU, treated 2.1 patients for CSU, and referred 3.0 patients with suspected CSU to a dermatologist or allergist. GPs' primary reasons for referral were seeking confirmation of CSU diagnosis (61.0%), seeking the specialist's opinion (51.2%), and not feeling confident in diagnosing or treating patients with CSU (42.7%). Most GPs had little to no knowledge of CSU (60.0%) or were unaware of the existence of CSU guidelines (61.1%). Among those who were aware of the guidelines, 35.1% applied them on a regular basis. Only 14.7% of GPs reported any use of PROs, and none used PROs with patients with CSU in the past 6 months. Lack of time hindered GPs from discussing PROs with patients all the time (28.6%), most of the time (42.9%), or sometimes (28.6%). Most GPs reported no or limited educational support on evidence-based practices from their clinics, and indicated the importance of further education on CSU diagnosis and management (72.6% important; 7.4% very important) and further training on PRO use (61.1% important; 8.4% very important) for enhancing CSU management. Conclusion Pre-implementation data revealed substantial knowledge gaps in CSU management among GPs in Lombardy, supporting the need for additional training to improve CSU management.