Schatz Michael, Zeiger Robert S, Mosen David, Apter Andrea J, Vollmer William M, Stibolt Thomas B, Leong Albin, Johnson Michael S, Mendoza Guillermo, Cook E Francis
Department of Allergy, San Diego, CA 92111, USA.
J Allergy Clin Immunol. 2005 Dec;116(6):1307-13. doi: 10.1016/j.jaci.2005.09.027. Epub 2005 Nov 8.
Prior studies suggest that allergist care improves asthma outcomes, but many of these studies have methodological shortcomings.
We sought to compare patient-based and medical utilization outcomes in randomly selected asthmatic patients cared for by allergists versus primary care providers.
A random sample of 3568 patients enrolled in a staff model health maintenance organization who were given diagnoses of persistent asthma completed surveys. Of these participants, 1679 (47.1%) identified a primary care provider as their regular source of asthma care, 884 (24.8%) identified an allergist, 693 (19.4%) reported no regular source of asthma care, and 195 (5.5%) identified a pulmonologist. Validated quality of life, control, severity, patient satisfaction, and self-management knowledge tools and linked administrative data that captured medication use were compared between groups, adjusting for demographics and baseline hospital and corticosteroid use.
Compared with those followed by primary care providers, patients of allergists reported significantly higher (P < .001) generic physical and asthma-specific quality of life, less asthma control problems, less severe symptoms, higher satisfaction with care, and greater self-management knowledge. Patients of allergists were less likely than patients of primary care providers to require an asthma hospitalization (odds ratio, 0.45) or unscheduled visit (odds ratio, 0.71) and to overuse beta-agonists (odds ratio, 0.47) and were more likely to receive inhaled steroids (odds ratio, 1.81) during their past year.
Allergist care is associated with a wide range of improved outcomes in asthmatic patients compared with care provided by primary care providers.
先前的研究表明，过敏症专科医生的治疗可改善哮喘治疗效果，但其中许多研究存在方法学上的缺陷。
我们试图比较由过敏症专科医生与初级保健提供者诊治的随机选择的哮喘患者的基于患者的结局和医疗利用结局。
对在一家员工模式健康维护组织登记的3568例被诊断为持续性哮喘的患者进行随机抽样并完成调查。在这些参与者中，1679例（47.1%）将初级保健提供者确定为其哮喘治疗的常规来源，884例（24.8%）确定为过敏症专科医生，693例（19.4%）报告没有哮喘治疗的常规来源，195例（5.5%）确定为肺科医生。在调整人口统计学因素以及基线住院情况和皮质类固醇使用情况后，对经过验证的生活质量、控制情况、严重程度、患者满意度和自我管理知识工具以及记录药物使用情况的相关管理数据进行组间比较。
与由初级保健提供者随访的患者相比，过敏症专科医生的患者报告的一般身体和哮喘特异性生活质量显著更高（P <.001），哮喘控制问题更少，症状不那么严重，对治疗的满意度更高，自我管理知识更丰富。与初级保健提供者的患者相比，过敏症专科医生的患者需要哮喘住院治疗（比值比，0.45）或非预约就诊（比值比，0.71）以及过度使用β受体激动剂（比值比，0.47）的可能性更小，并且在过去一年中更有可能接受吸入性类固醇治疗（比值比，1.81）。
与初级保健提供者提供的治疗相比，过敏症专科医生的治疗与哮喘患者广泛的改善结局相关。
