Quality of Care and Outcomes of Adults With Asthma Treated by Specialists and Generalists in Managed Care

Wu, Albert W.; Young, Yuchi; Skinner, Elizabeth A.; Diette, Gregory B.; Huber, Michael; Peres, Alan; Steinwachs, Donald M.

doi:10.1001/archinte.161.21.2554

Cited by 90 publications

(61 citation statements)

References 29 publications

(28 reference statements)

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“…17 The greater attention paid by allergists to the allergic status of their asthma patients may contribute to the observed differences in asthma outcomes between generalists and allergists: patients of allergists were less likely than those of generalists to seek emergency medical care for their asthma and had greater improvement in asthma symptom scores. 18 In conclusion, most adult asthma outpatients had evidence of atopy. Awareness of the high rate of atopy among asthma patients might improve patient management by prompting physicians to discuss allergen avoidance as well as medical treatment for both allergies and asthma.…”

Section: Discussionmentioning

confidence: 82%

Sensitization to Common Allergens in Adults with Asthma

Allen‐Ramey¹,

Schoenwetter²,

Weiss³

et al. 2005

The Journal of the American Board of Family Medicine

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Purpose: To estimate the prevalence of atopy (ie, allergen sensitization) in a sample of adult asthma outpatients.Methods: Population consisted of a total of 218 patients, 18 to 55 years of age, who were currently receiving care for asthma; and 13 physicians, whose specialties were Family Practice, Allergy, or Pulmonology and who were providing care to at least 10 to 15 asthma patients weekly. Patients provided a blood sample for quantification of total and allergen-specific IgE. Outcomes were the proportion of patients with atopy and the proportions of patients with elevated serum IgE specific to each of 8 specific common allergens.Results: The patients' mean age was 42 years, and 74% were women; 68% of patients met the study definition of atopy. Total serum IgE > 114 kU/L was observed in 48% of patients, and 59% had elevated levels of IgE specific to one or more of 8 common allergens.Conclusions: The majority of adult asthma outpatients had evidence of atopy and most were sensitive to a specific identifiable allergen. Awareness of the high prevalence of atopy among asthma patients might improve patient management. (J Am Board Fam Pract 2005;18:434 -9.)

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Section: Discussionmentioning

confidence: 82%

Sensitization to Common Allergens in Adults with Asthma

Allen‐Ramey¹,

Schoenwetter²,

Weiss³

et al. 2005

The Journal of the American Board of Family Medicine

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“…At this point his perception of the disease changes, as does his behaviour. General practitioners (GP) are often at the forefront in the management of asthmatics [39][40][41].…”

Section: Discussionmentioning

confidence: 99%

“…Self-management methods and action plans are more generally used by Anglo-Saxon GPs who have benefited from more widespread use of self-management programs in the USA and in UK [40,41]. These studies on self-management and general medicine indicate that it is necessary to more widely spread recommendations for self-management use to GPs because it is easily manageable in daily practice.…”

Section: Discussionmentioning

confidence: 99%

Impact of Long-term Employment of a Self-Management Program in Asthmatics

Devouassoux¹,

Freymond²,

Laforest³

et al. 2017

J Pulm Respir Med

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“…While it has been postulated that patients with particular illnesses have improved clinical outcomes and adherence to treatment guidelines when cared for by a subspecialist as compared to a generalist, [3,4] the association has not always been shown to be a strong one. [5] Some suggest that patients with chronic illnesses may be most effectively cared for through co-management by both generalists and subspecialists.…”

Section: Introductionmentioning

confidence: 99%

The outpatient assessment of patients with anemia by a general internal medicine service

McFadgen

Couban

Doucette

et al. 2017

JHA

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At the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, 2,400-2,800 new outpatient referrals for hematology consultation are received annually and approximately 10% of these referrals are specifically for isolated anemia. In recent years, such referrals have been sent from hematology to general internal medicine (GIM) for assessment and management. A retrospective chart review was conducted of a cohort of 99 patients from 2013 to describe the demographics, assessment, management and outcome of these patients, as well as to inform whether this practice should continue. The median age of patients was 60.3 years (min 19.4, max 97.6) and 62% were female. The median hemoglobin level was 109.0 g/L (min 66, max 137) at the time of referral and the median wait time was 53 days (min 8 days, max 171 days). Pearson's correlation analysis revealed that those with lower hemoglobin levels were seen more quickly. The patients had an additional 2.8 comorbidities on average, and were significantly more likely to receive non-anemia related adjustment to care with increasing number of comorbidities. A small proportion of patients (n = 5, 5.1%) were referred from GIM back to hematology, whereas 21% were referred to gastroenterology. A small number of patients (n = 5, 5.1%) underwent a bone marrow aspirate and biopsy. The most common diagnoses identified in the initial clinic letters were iron deficiency anemia (n = 59, 59.6%) and anemia of chronic disease (n = 8, 8.1%). 26.3% did not have a diagnosis identified. These findings support our practice to have patients with an isolated anemia evaluated by a general internist rather than a hematologist. Most of these patients had iron deficiency anemia or the anemia of chronic disease and received additional care for their comorbid conditions in the GIM clinic. Further work will help to define how such patients can be most effectively assessed and treated.

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Quality of Care and Outcomes of Adults With Asthma Treated by Specialists and Generalists in Managed Care

Abstract: In a managed health care setting, physicians' specialty training and self-reported expertise in treating asthma were related to better patient-reported care and outcomes.

Cited by 90 publications

References 29 publications

Sensitization to Common Allergens in Adults with Asthma

Sensitization to Common Allergens in Adults with Asthma

Impact of Long-term Employment of a Self-Management Program in Asthmatics

The outpatient assessment of patients with anemia by a general internal medicine service

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