Pulmonary and Allergy Subspecialty Care in Adults with Asthma. Treatment, Use of Services, and Health Outcomes

Details

• Personal Author:
  Blanc PD ; Henke J ; Katz PP ; Smith S ; Yelin EH
• Description:
  To study the relationship between physician subspecialty practice type and health measures in patients with adult asthma, we prospectively studied 601 adults with asthma. The subjects were recruited from a random sample of board-certified pulmonary or allergy internal medicine subspecialists practicing in northern California; 539 patients (90%) were restudied after 18 months. Structured telephone interviews were used to elicit demographics, clinical variables, and measures of asthma severity, asthma-specific quality of life, and physical function status. At baseline and follow-up, 283 subjects (53%) reported their principal asthma care provider type as a pulmonary specialist throughout and 150 (28%) as an allergy specialist throughout, 53 (10%) switched provider type during follow-up, and 53 (10%) reported that their principal asthma care physician was from neither subspecialist group. Taking into account illness severity and other demographic and clinical covariates, the group whose principal asthma care came from an allergy subspecialist was more likely than the pulmonary specialist-care group to report possessing a peak expiratory flow rate meter (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.8 to 4.6) and less likely to be receiving high-dose inhaled steroids (OR, 0.3; 95% CI, 0.1 to 0.6). Taking into account demographic and clinical covariates, allergists' care was related to worse subject-reported asthma-specific quality of life (P = 0.02), but not to statistically increased risk of hospitalization, decreased physical function, or an increased number of reported health-related restricted-activity days. We observed subject-reported specialist variation in management and health outcomes among adults with asthma not accounted for by differing disease severity or other clinical and demographic variables. [Description provided by NIOSH]
• Subjects:
  Age Factors Asthma Asthma, Occupational Demography Hypersensitivity Mental Health Occupational Health Race Factors Respiratory Tract Diseases Safety Sex Characteristics Smokers

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• Keywords:
  Age-factors Allergies Bronchial-asthma Demographic-characteristics Psychological-factors Pulmonary-system-disorders Racial-factors Respiratory-system-disorders Sex-factors Smoking
• ISSN:
  0093-0415
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  California ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  398-407
• Volume:
  167
• Issue:
  6
• NIOSHTIC Number:
  nn:20024644
• Citation:
  West J Med 1997 Dec; 167(6):398-407
• Contact Point Address:
  Paul Blanc, MD, MSPH, Box 0924, UCSF, San Francisco, CA 94143-0924
• Federal Fiscal Year:
  1998
• NORA Priority Area:
  Research Tools and Approaches: Social and Economic Consequences
• Performing Organization:
  University of California, Cardiovascular Research Institute, San Francisco, California
• Peer Reviewed:
  True
• Start Date:
  19970930
• Source Full Name:
  Western Journal of Medicine
• End Date:
  20010929
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:6a44355a99d11be0fbd023f943eadd741d878566b1cbf58272dd3bd1203931d144db4e89d23622085321dc21ef72b78e2189941af37d5ecdb6f45c000347a8dc
• Download URL:
  https://stacks.cdc.gov/view/cdc/196339/cdc_196339_DS1.pdf
• File Type:
  [PDF - 2.07 MB ]