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The recent review by Donohoe¹ on specialist and generalist care omitted important data focusing on the treatment of adults with asthma. Taken together, these studies suggest that asthma specialists provide superior asthma care, both in terms of process and outcome measures. A recent cross-sectional study² from a large health maintenance organization found that most patients with moderate to severe asthma treated by allergists received inhaled anti-inflammatory therapy (92%), compared with less than half of patients treated by generalists (42%). Even though the allergists treated patients with greater asthma severity, their patients had significantly better measures of generic health status (SF-36), especially physical functioning and general health. Since all patients were members of the same health maintenance organization, these differences cannot be explained by differences in health care access. Furthermore, studies of adults with severe asthma as indicated by high previous health care utilization for asthma, have demonstrated improved outcomes with . . . [Full Text of this Article]

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Comparing Generalist and Specialty Care: Discrepancies, Deficiencies, and Excesses
Martin T. Donohoe
Arch Intern Med. 1998;158(15):1596-1608.
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