SPECIALTY DIFFERENCES IN THE MANAGEMENT OF ASTHMA - A CROSS-SECTIONALASSESSMENT OF ALLERGISTS PATIENTS AND GENERALISTS PATIENTS IN A LARGEHMO

Objective: To examine the differences in medical management and qualit y of life between patients with asthma who receive their primary asthm a care from allergists and those who receive their care from generalis ts in a large health maintenance organization (HMO). Methods: We condu cted a cross-sectional study of patients with asthma in a large HMO (K aiser Permanente, Northwest Region, Portland, Ore). Participants were 392 individuals aged 15 through 55 years with physician-diagnosed asth ma, taking antiasthma medications, reporting current asthma symptoms, and receiving asthma care from an allergist or from a generalist. Prim ary outcomes include characteristics of asthma, health care utilizatio n, and quality of life. Results: Patients cared for by allergists tend ed 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 l ikely 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 gene ralists' patients to report using inhaled antiinflammatory agents (P<. 01), oral steroids (P<.01), and regular (daily) breathing medications to control their asthma (P<.01). Allergists' patients were; more likel y to have asthma exacerbations treated in a clinic setting rather than an emergency department (P<.01). Furthermore, allergists' patients re ported significantly improved quality of life as measured by several d imensions of the SF-36 scale (physical functioning, role emotional, bo dily pain, and general health; P<.05) Conclusions: These findings sugg est that specialist care of asthma is of benefit for patients with ast hma in a large HMO. Specifically, the allergists' patients conformed m ore closely to national asthma management guidelines and reported bett er quality of life than did the generalists' patients.