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ARTICLE |

Specialty Differences in the Management of Asthma:  A Cross-sectional Assessment of Allergists' Patients and Generalists' Patients in a Large HMO

William M. Vollmer, PhD; Mark O'Hollaren, MD; Kenneth M. Ettinger, MD; Thomas Stibolt, MD; John Wilkins, MD; A. Sonia Buist, MD; Kathryn L. P. Linton, MS; Molly L. Osborne, MD, PhD
Arch Intern Med. 1997;157(11):1201-1208. doi:10.1001/archinte.1997.00440320095009.
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Objective:  To examine the differences in medical management and quality of life between patients with asthma who receive their primary asthma care from allergists and those who receive their care from generalists in a large health maintenance organization (HMO).

Methods:  We conducted a cross-sectional study of patients with asthma in a large HMO (Kaiser Permanente, Northwest Region, Portland, Ore). Participants were 392 individuals aged 15 through 55 years with physician-diagnosed asthma, taking antiasthma medications, reporting current asthma symptoms, and receiving asthma care from an allergist or from a generalist. Primary outcomes include characteristics of asthma, health care utilization, and quality of life.

Results:  Patients cared for by allergists tended to have more severe asthma than those cared for by generalists (P<.01). The allergists' patients tended to be older (38.6±9.6 years vs 35.7±12.6 years, P<.01), more atopic (91% vs 78%, P<.01), and more likely to report perennial (rather than seasonal) asthma (26% vs 36%, P<.04) than the generalists' patients. Patients receiving their primary asthma care from an allergist were considerably more likely than generalists' patients to report using inhaled anti-inflammatory agents (P<.01), oral steroids (P<.01), and regular (daily) breathing medications to control their asthma (P<.01). Allergists' patients were more likely to have asthma exacerbations treated in a clinic setting rather than an emergency department (P<.01). Furthermore, allergists' patients reported significantly improved quality of life as measured by several dimensions of the SF-36 scale (physical functioning, role emotional, bodily pain, and general health; P<.05).

Conclusions:  These findings suggest that specialist care of asthma is of benefit for patients with asthma in a large HMO. Specifically, the allergists' patients conformed more closely to national asthma management guidelines and reported better quality of life than did the generalists' patients.Arch Intern Med. 1997;157:1201-1208

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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