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

<h2>Abstract</h2><h3>Introduction</h3> 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. <h3>Methods</h3> 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. <h3>Results</h3> 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. <h3>Conclusion</h3> Pre-implementation data revealed substantial knowledge gaps in CSU management among GPs in Lombardy, supporting the need for additional training to improve CSU management.