Better Outcomes at Lower Cost - American College of Allergy ...

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Asthma TreatmentOutcomesWith their years of specialty training andclinical experience in asthma management,allergists are more likely to follow the state-ofthe-arttreatment plans that improve outcomesand reduce costs, and to adhere to practiceguidelines that experts agree are the standardof care. Numerous clinical studies confirm thatspecialists are more likely than non-specialiststo manage asthma based on the latest clinicalstudy findings, to identify and implementprocedures to reduce allergy triggers for thedisease, and to follow consensus guidelines. Itis well documented that asthma care deliveredunder the supervision of an allergist results inimproved outcomes and more effective use ofhealthcare resources. For example:• A survey of 1,954 patients and their 1,078physicians enrolled in 12 managed careorganizations analyzed the relationshipbetween physician specialty and treatmentoutcomes, using indicators from the NIHGuidelines as outcome measures. Asthmacare provided by specialists was consistentlyassociated with better patient outcomesacross a range of relevant indicatorscompared to care provided by generalists.The patients of allergists reported:– fewer hospitalizations and emergencyroom visits for asthma– higher ratings for the quality of care– fewer restrictions in activities because ofasthma symptoms– improved physical functioning [16]• A comparative evaluation of 301 worker’scompensation claimants with work-relatedasthma found that only 36.9 percent weretreated by specialists, either initially orthrough the course of their claim. Fewer thanhalf of the workers had received an objectiveevaluation of pulmonary function. Thosetreated by specialists were significantly morelikely to have received diagnostic testing(82.9 percent) compared to those treated bygeneralists (20 percent). [17]• In a random sample of 3,568 patients withpersistent asthma enrolled in a healthmaintenance organization, 1,079 patientswho were treated by asthma specialistsreported significantly higher general physicaland asthma-specific quality of life, fewerasthma control problems, fewer severesymptoms, higher satisfaction with care andgreater self-management knowledge,compared with 1,679 patients followed byprimary care physicians. Patients of allergistswere less likely to be hospitalized, haveunscheduled visits for their asthma or tooveruse beta-agonist medications. [18] Inrelated studies, the researchers found thateffective management strategies are associatedwith better asthma control, even afteraccounting for high-risk characteristics. Inthese studies, asthma specialist care wasindependently associated with better diseasecontrol. [19-20]• A study from Johns Hopkins Universityfound that children enrolled in two managedcare organizations were significantly lesslikely to be treated according to NIHGuidelines if their asthma was managed by aprimary care physician, compared tomanagement by an asthma specialist. Therewere major differences between the two typesof care at all levels, with specialists receivinghigher scores for the appropriate use ofmedications, patient education, assessment andmonitoring of asthma, and control of riskfactors that make a child’s asthma worse. [21]• A Canadian study underscores the problemof inappropriate medication use. Of 6,254asthma patients age 65 or older who werehospitalized for asthma, 2,495 (40 percent)did not receive a prescription for inhaledcorticosteroid therapy – a mainstay of asthma6
control according to NIH Guidelines – afterfollow-up of 90 days post-discharge. Thepatients of asthma specialists weresignificantly more likely to receive therecommended therapy compared to thepatients of general physicians. [22]• A survey of parents of 1,648 Medicaidinsuredchildren with asthma enrolled in fivemanaged care plans found widespreadunderuse of controller medications. Treatmentby an allergist was associated with moreappropriate use of these medications. [23]• A study of more than 2,300 children withasthma in the Massachusetts Medicaidprogram found that children in a staff-modelhealth maintenance organization (HMO)were nearly twice as likely to receivespecialist care as those in a state-administeredprimary care case manager plan.Consequently, the children in the HMO wereonly 54 percent as likely to require anemergency department visit or hospitalization,only half as likely to meet nationaldefinitions for persistent asthma and nearlythree times as likely to receive timely followupcare. [24]Because of these benefits, administrators ofmany health care plans and managed careorganizations strive to involve allergists inasthma care. When managed aggressively by aspecialist, asthma does not have to be a lifethreateningor disabling disease. In mostpatients, the condition can be controlled sothat acute asthma attacks are avoided.Use of HealthcareResourcesHospitalizationsNumber of HospitalizationsResearch shows that many of the nearly onehalfmillion hospital admissions [2] for asthmacould be avoided if patients received specialistcare.1201008060402077%reduction inhospitalizationswith asthmaspecialists0Non-SpecialistCareSpecialistCareASTHMAHOSPITALIZATIONSSource: National Jewish Medical and Research Center.Medical Scientific Update. 1998.7
Page 1: Asthma Managementand the Allergist:
Page 5 and 6: SummaryAsthma is among the most com
Page 7 and 8: Asthma in America• Affects 22 mil
Page 9: When To Refer toan AllergistAccordi
Page 13 and 14: Number of Visits3503002502001501004
Page 15 and 16: Emergency Room VisitsInpatient Care
Page 17 and 18: symptoms and when to seek help for
Page 19 and 20: Specialty Care of Asthmain Health P
Page 21 and 22: References1. Centers for Disease Co
Page 23 and 24: 40. Legorreta AP, Christian-Herman
Page 25 and 26: Finkelstein JA, Lozano P, Shulruff
Page 27 and 28: two subspecialty groups: allergists
Page 29 and 30: Specific findings: The Epidemiology
Page 32: When To Refer to an AllergistPatien

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