This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Social Bookmarking   What's this?

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.

Abstract
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

Author Affiliations
From the Kaiser Permanente Center for Health Research (Dr Vollmer and Ms Linton); Northwest Permanente, PC (Drs Ettinger and Stibolt); Department of Medicine (Dr O'Hollaren) and Division of Pulmonary and Critical Care Medicine (Drs Wilkins and Buist), Oregon Health Sciences University, and the Division of Pulmonary and Critical Care Medicine, Portland Veterans Administration Medical Center (Dr Osborne), Portland, Ore.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Impact of Asthma Specialists on Patient Outcomes
Mark D. Eisner and Martin Donohoe
Arch Intern Med. 1999;159(2):196-197.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Follow-up after Acute Asthma Episodes: What Improves Future Outcomes?
Schatz et al.
Proc Am Thorac Soc 2009;6:386-393.
FULL TEXT  

The Paradox of Primary Care
Stange and Ferrer
Ann Fam Med 2009;7:293-299.
FULL TEXT  

Subspecialty Differences in Asthma Characteristics and Management
Chen et al.
Mayo Clin Proc. 2008;83:786-793.
ABSTRACT | FULL TEXT  

Patterns of Inhaled Antiinflammatory Medication Use in Young Underserved Children With Asthma
Butz et al.
Pediatrics 2006;118:2504-2513.
ABSTRACT | FULL TEXT  

Asthma Guideline Use by Pediatricians in Private Practices and Asthma Morbidity
Cloutier et al.
Pediatrics 2006;118:1880-1887.
ABSTRACT | FULL TEXT  

Effectiveness of Nebulizer Use-Targeted Asthma Education on Underserved Children With Asthma
Butz et al.
Arch Pediatr Adolesc Med 2006;160:622-628.
ABSTRACT | FULL TEXT  

National Heart, Lung, and Blood Institute Guidelines and Asthma Management Practices Among Inner-City Pediatric Primary Care Providers
Rastogi et al.
Chest 2006;129:619-623.
ABSTRACT | FULL TEXT  

Randomized Controlled Trial of Emergency Department Interventions To Improve Primary Care Follow-up for Patients With Acute Asthma.
Baren et al.
Chest 2006;129:257-265.
ABSTRACT | FULL TEXT  

Management of asthma in patients supervised by primary care physicians or by specialists
Laforest et al.
Eur Respir J 2006;27:42-50.
ABSTRACT | FULL TEXT  

Fast Facts: Asthma
Brown
Chest 2005;128:4053-4053.
ABSTRACT | FULL TEXT  

Categorizing Asthma Severity: An Overview of National Guidelines
Colice
Clin Med Res 2004;2:155-163.
ABSTRACT | FULL TEXT  

Influence of Health Care Providers on the Development of Diabetes Complications: Long-term follow-up from the Pittsburgh Epidemiology of Diabetes Complications Study
Zgibor et al.
Diabetes Care 2002;25:1584-1590.
ABSTRACT | FULL TEXT  

Effectiveness of an Asthma Management Program for Pediatric Members of a Large Health Maintenance Organization
Lukacs et al.
Arch Pediatr Adolesc Med 2002;156:872-876.
ABSTRACT | FULL TEXT  

A Prospective Multicenter Study of Patient Factors Associated With Hospital Admission From the Emergency Department Among Children With Acute Asthma
Pollack et al.
Arch Pediatr Adolesc Med 2002;156:934-940.
ABSTRACT | FULL TEXT  

Patient Factors and Medication Guideline Adherence Among Older Women With Asthma
Barr et al.
Arch Intern Med 2002;162:1761-1768.
ABSTRACT | FULL TEXT  

Understanding and Use of Inhaler Medication by Asthmatics in Specialty Care in Trinidad* : A Study Following Development of Caribbean Guidelines for Asthma Management and Prevention
Pinto Pereira et al.
Chest 2002;121:1833-1840.
ABSTRACT | FULL TEXT  

Underuse of Controller Medications Among Medicaid-Insured Children With Asthma
Finkelstein et al.
Arch Pediatr Adolesc Med 2002;156:562-567.
ABSTRACT | FULL TEXT  

Quality of Care and Outcomes of Adults With Asthma Treated by Specialists and Generalists in Managed Care
Wu et al.
Arch Intern Med 2001;161:2554-2560.
ABSTRACT | FULL TEXT  

Socioeconomic Status, Drug Insurance Benefits, and New Prescriptions for Inhaled Corticosteroids in Schoolchildren With Asthma
Kozyrskyj et al.
Arch Pediatr Adolesc Med 2001;155:1219-1224.
ABSTRACT | FULL TEXT  

The CGHA Asthma Management Program and Its Effect Upon Pediatric Asthma Admission Rates
Martin
CLIN PEDIATR 2001;40:425-434.
ABSTRACT  

Comparison of Quality of Care by Specialist and Generalist Physicians as Usual Source of Asthma Care for Children
Diette et al.
Pediatrics 2001;108:432-437.
ABSTRACT | FULL TEXT  

Race and Sex Differences in Consistency of Care With National Asthma Guidelines in Managed Care Organizations
Krishnan et al.
Arch Intern Med 2001;161:1660-1668.
ABSTRACT | FULL TEXT  

Treatment Process and Outcomes for Managed Care Patients Receiving New Antidepressant Prescriptions From Psychiatrists and Primary Care Physicians
Simon et al.
Arch Gen Psychiatry 2001;58:395-401.
ABSTRACT | FULL TEXT  

Underuse of Inhaled Steroid Therapy in Elderly Patients With Asthma
Sin and Tu
Chest 2001;119:720-725.
ABSTRACT | FULL TEXT  

Clinical Practice Guidelines vs Actual Clinical Practice : The Asthma Paradigm
Crim
Chest 2000;118 :62S-64S.
ABSTRACT | FULL TEXT  

Prolonged Episodes of Persistent Asthma: A Distinct Clinical Pattern With Characteristic Clinical Features
Chang et al.
Chest 2000;117:944-949.
ABSTRACT | FULL TEXT  

Asthma education and patient monitoring
CMAJ 1999;161:s15-19.
FULL TEXT  

Asthma Care Practices, Perceptions, and Beliefs of Chicago-Area Asthma Specialists
Moy et al.
Chest 1999;116 :154S-162S.
ABSTRACT | FULL TEXT  

A Survey of Asthma Care in Managed Care Organizations: Results From the Chicago Asthma Surveillance Initiative
Nelson et al.
Chest 1999;116 :173S-178S.
ABSTRACT | FULL TEXT  

Restructuring Asthma Care in a Hospital Setting to Improve Outcomes
Evans et al.
Chest 1999;116 :210S-216S.
ABSTRACT | FULL TEXT  

Asthma Guidelines . An Assessment of Physician Understanding and Practice
DOERSCHUG et al.
Am. J. Respir. Crit. Care Med. 1999;159:1735-1741.
ABSTRACT | FULL TEXT  

Impact of Asthma Specialists on Patient Outcomes
Eisner and Donohoe
Arch Intern Med 1999;159:196-197.
FULL TEXT  

Health Service Use by African Americans and Caucasians with Asthma in a Managed Care Setting
ZORATTI et al.
Am. J. Respir. Crit. Care Med. 1998;158:371-377.
ABSTRACT | FULL TEXT  

Developing a Tool for Analyzing Medical Care Utilization of Adult Asthma Patients in Indemnity and Managed Care Plans: Can an Episodes of Care Framework Be Used?
Rosen and Mayer-Oakes
American Journal of Medical Quality 1998;13:203-212.
ABSTRACT  

Environmental Tobacco Smoke and Adult Asthma . The Impact of Changing Exposure Status on Health Outcomes
EISNER et al.
Am. J. Respir. Crit. Care Med. 1998;158:170-175.
ABSTRACT | FULL TEXT  

Subspecialty Systems for Primary Care Providers: A New Alliance
Ault et al.
Arch Intern Med 1998;158:542-542.
FULL TEXT  

SPECIALTY DIFFERENCES IN OUTCOMES OF ASTHMA CARE
JWatch General 1997;1997:6-6.
FULL TEXT