Vollmer W M, O'Hollaren M, Ettinger K M, Stibolt T, Wilkins J, Buist A S, Linton K L, Osborne M L
Kaiser Permanente Center for Health Research, Portland, OR, USA.
Arch Intern Med. 1997 Jun 9;157(11):1201-8.
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).
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.
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).
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.
在一个大型健康维护组织（HMO）中，研究由过敏症专科医生提供初级哮喘护理的哮喘患者与由全科医生提供护理的哮喘患者在医疗管理和生活质量方面的差异。
我们对一个大型HMO（俄勒冈州波特兰市西北地区的凯撒医疗集团）中的哮喘患者进行了一项横断面研究。参与者为392名年龄在15至55岁之间、经医生诊断患有哮喘、正在服用抗哮喘药物、报告有当前哮喘症状且从过敏症专科医生或全科医生处接受哮喘护理的个体。主要结局包括哮喘特征、医疗保健利用情况和生活质量。
由过敏症专科医生护理的患者哮喘往往比由全科医生护理的患者更严重（P < 0.01）。过敏症专科医生的患者往往年龄更大（38.6±9.6岁对35.7±12.6岁，P < 0.01），特应性更强（91%对78%，P < 0.01），并且比全科医生的患者更有可能报告患有常年性（而非季节性）哮喘（26%对36%，P < 0.04）。从过敏症专科医生处接受初级哮喘护理的患者比全科医生的患者更有可能报告使用吸入性抗炎药（P < 0.01）、口服类固醇（P < 0.01）和常规（每日）呼吸药物来控制哮喘（P < 0.01）。过敏症专科医生的患者在诊所环境而非急诊科接受哮喘加重治疗的可能性更大（P < 0.01）。此外，通过SF - 36量表的几个维度（身体功能、角色情感、身体疼痛和总体健康）衡量，过敏症专科医生的患者报告生活质量有显著改善（P < 0.05）。
这些发现表明，在大型HMO中，哮喘专科护理对哮喘患者有益。具体而言，过敏症专科医生的患者比全科医生的患者更严格地遵循国家哮喘管理指南，并且报告生活质量更好。
