BALTIMORE—The results of a cross-sectional study have shown that specialists provide better pediatric asthma care than do generalists in such realms as appropriate medication use, education and instruction, assessment, and monitoring and control of asthma-exacerbating factors.[1]

Diette and coworkers from Johns Hopkins University obtained reports from parents of 260 children with asthma who were enrolled in two managed care organizations; the researchers compared the care the children received with 1997 National Asthma Education and Prevention Program Guidelines. After adjustment for symptom severity, recent care encounters, and parental demographics, the results were clear: Guidelines were more likely to be followed when parents consulted specialists rather than primary care physicians for asthma treatment. The study included assessments of each child’s general health and asthma symptoms; the impact of those symptoms on the child’s mental and physical health; the use of health services, treatments, and medications; the ability of the child and parents to participate in care; parental estimations of the quality of care; and the amount of asthma education provided.

In addition, parents were required to answer two questions about the usual source of care for their child’s asthma. Researchers first asked whether the provider most frequently seen was a specialist, such as an allergist or a pulmonologist, or if said provider was a generalist, such as a pediatrician, internist, or family practitioner. Next, parents were asked about the circumstances under which they would call a specialist or generalist for asthma care. Specifically, whom would they call:

Parents reported that asthma care was provided by a specialist in 15% of all cases, by a generalist in 75%, and by both in 10%. As for the two circumstances under which parents might call a physician, 78% of respondents said they would always call the generalist, while another 10% said they would always call the specialist.

Guidelines were most likely to be met in any instance when a specialist was contacted for asthma care. Ninety-four percent of patients who visited specialists used controller medications, while only 72% of those who saw generalists did. Similarly, 69% of those who saw specialists received written instructions for asthma control, compared with 46% of those who saw generalists. Instruction in the use of inhalers was given by 89% of specialists and 69% of generalists. Pulmonary function testing was provided by 85% and 48%, respectively.

The study authors noted, “In this study, we found that patients who saw specialists differed in some characteristics, including symptom severity, age, race, and the education and work status of the parents.” But this did not change the fact that care was better if provided by a specialist. They suggested shifting pediatric asthma care to specialists. Development of treatment strategies for both specialists and generalists to improve the quality of pediatric asthma care, they stated, might be another solution.

—Owen McCarthy

Reference
1. Diette GB, Skinner EA, Nguyen TT, et al. Comparison of quality of care by specialist and generalist physicians as usual source of asthma care for children. Pediatrics. 2001;108:432-437.

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