Health care education, delivery, and quality
Improved asthma outcomes from allergy specialist care: A population-based cross-sectional analysis

https://doi.org/10.1016/j.jaci.2005.09.027Get rights and content

Background

Prior studies suggest that allergist care improves asthma outcomes, but many of these studies have methodological shortcomings.

Objective

We sought to compare patient-based and medical utilization outcomes in randomly selected asthmatic patients cared for by allergists versus primary care providers.

Methods

A random sample of 3568 patients enrolled in a staff model health maintenance organization who were given diagnoses of persistent asthma completed surveys. Of these participants, 1679 (47.1%) identified a primary care provider as their regular source of asthma care, 884 (24.8%) identified an allergist, 693 (19.4%) reported no regular source of asthma care, and 195 (5.5%) identified a pulmonologist. Validated quality of life, control, severity, patient satisfaction, and self-management knowledge tools and linked administrative data that captured medication use were compared between groups, adjusting for demographics and baseline hospital and corticosteroid use.

Results

Compared with those followed by primary care providers, patients of allergists reported significantly higher (P < .001) generic physical and asthma-specific quality of life, less asthma control problems, less severe symptoms, higher satisfaction with care, and greater self-management knowledge. Patients of allergists were less likely than patients of primary care providers to require an asthma hospitalization (odds ratio, 0.45) or unscheduled visit (odds ratio, 0.71) and to overuse β-agonists (odds ratio, 0.47) and were more likely to receive inhaled steroids (odds ratio, 1.81) during their past year.

Conclusions

Allergist care is associated with a wide range of improved outcomes in asthmatic patients compared with care provided by primary care providers.

Section snippets

Patients

Surveys were sent as part of a quality assessment and improvement project by the Kaiser Permanente Care Management Institute in August 2000 to a random sample (using medical record numbers) of Kaiser Permanente Medical Care Program adult members aged 18 to 56 years from the Northern California (n = 3072), Northwest (n = 543), and Southern California (n = 3251) regions (Fig 1) who were given diagnoses of persistent asthma on the basis of the presence of one or more of the following National

Results

Of the 3765 patients who completed the survey, 3568 answered the question regarding their regular source of asthma care. Of these patients, 1679 (47.1%) identified a primary care physician, 884 (24.8%) identified an allergist, 195 (5.5%) identified a pulmonologist, 118 (3.3%) identified an asthma care manager, and 692 (19.4%) reported they had no regular asthma care provider. Because such a small number of patients identified a care manager and because care managers do not function autonomously

Discussion

Asthma is an extremely common medical illness that causes substantial morbidity, including hospitalizations, emergency department visits, and reduced quality of life.20 It is therefore important to identify processes of care that reduce such morbidity. This study demonstrates that patients of allergists experience fewer hospitalizations and unscheduled visits, less need for rescue therapy, higher asthma-specific quality of life, less symptoms, more asthma control, and increased satisfaction

References (26)

  • W.M. Vollmer et al.

    Specialty differences in the management of asthma

    Arch Intern Med

    (1997)
  • G.B. Diette et al.

    Treatment patterns among adult patients with asthma

    Arch Intern Med

    (1999)
  • C.S. Kelly et al.

    Outcomes evaluation of a comprehensive intervention program for asthmatic children enrolled in Medicaid

    Pediatrics

    (2000)
  • Cited by (0)

    Supported by Kaiser Permanente Care Management Institute.

    Disclosure of potential conflict of interest: R. Zeiger has consultant arrangements with Novartis, Genentech, GlaxoSmithKline, and Aventis and has received grants from GlaxoSmithKline and Aventis. All other authors—none disclosed.

    View full text