Comparison of quality of care by specialist and generalist physicians as usual source of asthma care for children.
OBJECTIVE
To determine whether care for children was more consistent with national asthma guidelines when a specialist rather than a generalist was the usual source of asthma care.


METHODS
Cross-sectional survey.


METHODS
Two large managed care organizations in the United States.


METHODS
A total of 260 parents of children with asthma.


METHODS
None.


METHODS
Parent reports of the physician primarily responsible for asthma care (specialist, generalist, or both equally) and whom they would call (specialist or generalist) for questions about asthma care were used to define usual source of care. We assessed consistency of care with 1997 National Asthma Education and Prevention Program guidelines using 11 indicators in 4 domains of asthma care: patient education, control of factors contributing to asthma symptoms, periodic physiologic assessment and monitoring, and proper use of medications.


RESULTS
In all 4 domains, care was more likely to be consistent with guidelines when specialists were the usual source of care. These differences remained after adjustment for symptom severity, recent care encounters, and parent demographics. Greatest differences for specialist versus generalist management were for use of controller medications (odds ratio [OR] 6.7; 95% confidence interval [CI]: 1.5-30.4), ever having a pulmonary function test (OR 6.5; 95% CI: 2.4-18.1), and having been told about asthma triggers and how to avoid them (OR 5.9; 95% CI: 1.3-26.2).


CONCLUSIONS
In these managed care organizations, asthma care in children was more likely to be consistent with national guidelines when a specialist was the primary provider. Greater use of specialists or altering generalist physicians' care may improve the degree to which the care of children with asthma is consistent with national guidelines.
Diette
G B
GB
Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205, USA. gdiette@mail.jhmi.edu
Skinner
E A
EA
Nguyen
T T
TT
Markson
L
L
Clark
B D
BD
Wu
A W
AW
D000293:Adolescent; D000367:Age Factors; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000628:therapy*; D017028:Caregivers / Q000523:psychology / Q000706:statistics & numerical data; D002648:Child; D002662:Child Health Services / Q000592:standards; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000592:standards; D008511:Medicine / Q000592:standards*; D010290:Parents / Q000523:psychology*; D010353:Patient Education as Topic / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D011787:Quality of Health Care; D013038:Specialization; D014481:United States
D018927:Anti-Asthmatic Agents