By David Douglas
WESTPORT, CT (Reuters Health) – A survey of almost 2000 asthmatic members of managed healthcare organizations shows higher care ratings for pulmonologists and allergists than for generalists.
Dr. Albert W. Wu of Johns Hopkins University, Baltimore, and colleagues note that there is some evidence that specialists treating acute illnesses achieve better outcomes. However, "for chronic illness the impact has been more elusive."
To investigate, and also to determine whether restricted access to specialists might have an effect, the researchers surveyed 1954 asthma patients enrolled in 12 managed care organizations. Also surveyed were the 1078 physicians involved in the treatment of these patients. The findings appeared in the November 26th issue of the Archives of Internal Medicine.
In total, 878 physicians were classified as being generalists, 204 as asthma-experienced generalists, 292 as pulmonologists and the remaining 382 as allergists. Among items evaluated were patient use of corticosteroids and peak flow meters, patient self-management, impact of asthma on activities, and hospitalizations and emergency department use.
Significant differences were seen in ratings for specialists and experienced generalists compared with those of generalists. For example, 41.9% of patients of generalists had peak flow meters, compared with 51.7% for those of experienced generalists and 53.8% for those of specialists.
Patients of specialists were "most satisfied with the care they received" and overall, there appeared to be "modest differences between the specialists that favor allergists." Compared with patients of generalists, patients of allergists had a significantly better record for hospitalizations and emergency asthma care. Those of pulmonologists "were more likely to rate improvement in symptoms as very good or excellent."
The researchers thus conclude that "physicians' specialty training and self-reported expertise in treating asthma were related to better patient-reported care and outcomes."
In light of these findings, Dr. Wu told Reuters Health that "clinicians should work to make sure their patients are getting the recommended treatments, and are able to manage their own asthma as much as possible." Physicians with less experience treating asthma, he added, "should refresh themselves on current guidelines, and consider referring their patients to more experienced colleagues."
Arch Intern Med 2001;161:2554-2560.
e-Med Tools
קצר קולע וממוקד
e-Med סמינרים
אי-מד תחקירים
Medscape Tools
Journal Club
מרכזי מידע ושירות
Facebook
מידע למפרסם
מאגר תרופות
מאגר אנשי המקצוע
אינדקס שימושי
חדשות משה"ב
eMed HealthClub
מחקרים קליניים
השאירו תגובה
רוצה להצטרף לדיון?תרגישו חופשי לתרום!