Developing an allergy management support system (AMSS) for primary care:Agreement between the AMSS and the allergy specialist

Background: Diagnosis and management of allergic patients is often initially and exclusively performed by GPs. Since the prevalence of allergy is increasing and many GPs report having difficulties in diagnosing and managing allergic patients, an Allergy Management Support System (AMSS) for primary care is under development. The aim of this study was to determine the agreement on allergy management between the AMSS and allergy specialists. Methods: The questionnaire of the AMSS was administered to patients suspected of being allergic who were referred by GPs to (pediatric) allergists or dermatologists. The responses were analyzed by 2 researchers who allocated the patients into predefined management categories using the algorithms of the AMSS. Based on the clinical correspondence, 2 allergists and 2 dermatologist allocated the same patients in the same way using their clinical knowledge, which was considered to be the gold standard. Agreement between the gold standard and the AMSS was investigated by ascertaining concordance of management categories. The inter-rater reliability between the specialists and researchers was calculated using Cohen's kappa. Results: 42 patients (38% male, mean age 26.2 years) completed the questionnaire. Mean time between completing the questionnaire and the consult with allergy specialist was 8 days (SD 11 days). Agreement between the gold standard and the AMSS was found in 69.2% (CI 67.2-71.2) of cases. There was moderate agreement between the allergists (k = 0.55, P <0.001) and the dermatologists (eczema body k = 0.53, P <0.001; eczema face k = 0.62, P = 0.003). Very good agreement was found between the researchers (k = 0.98, P <0.001). Conclusion: The agreement between the allergy specialists (gold standard) and the AMSS was fairly good. Based on these preliminary results allocation of patients into management categories by the AMSS may be further improved. The next step will be investigation of the feasibility of the AMSS in primary care