title: Improved asthma outcomes from allergy specialist care: a population-based cross-sectional analysis.
abstract: BACKGROUND
  Prior studies suggest that allergist care improves asthma outcomes, but many of these studies have methodological shortcomings.
  
  
  OBJECTIVE
  We sought to compare patient-based and medical utilization outcomes in randomly selected asthmatic patients cared for by allergists versus primary care providers.
  
  
  METHODS
  A random sample of 3568 patients enrolled in a staff model health maintenance organization who were given diagnoses of persistent asthma completed surveys. Of these participants, 1679 (47.1%) identified a primary care provider as their regular source of asthma care, 884 (24.8%) identified an allergist, 693 (19.4%) reported no regular source of asthma care, and 195 (5.5%) identified a pulmonologist. Validated quality of life, control, severity, patient satisfaction, and self-management knowledge tools and linked administrative data that captured medication use were compared between groups, adjusting for demographics and baseline hospital and corticosteroid use.
  
  
  RESULTS
  Compared with those followed by primary care providers, patients of allergists reported significantly higher (P < .001) generic physical and asthma-specific quality of life, less asthma control problems, less severe symptoms, higher satisfaction with care, and greater self-management knowledge. Patients of allergists were less likely than patients of primary care providers to require an asthma hospitalization (odds ratio, 0.45) or unscheduled visit (odds ratio, 0.71) and to overuse beta-agonists (odds ratio, 0.47) and were more likely to receive inhaled steroids (odds ratio, 1.81) during their past year.
  
  
  CONCLUSIONS
  Allergist care is associated with a wide range of improved outcomes in asthmatic patients compared with care provided by primary care providers.
authors.affiliation: Department of Allergy, San Diego, CA 92111, USA. michael.x.schatz@kp.org
authors.forename: Michael
authors.initials: M
authors.lastname: Schatz
authors.forename: Robert S
authors.initials: RS
authors.lastname: Zeiger
authors.forename: David
authors.initials: D
authors.lastname: Mosen
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Apter
authors.forename: William M
authors.initials: WM
authors.lastname: Vollmer
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Stibolt
authors.forename: Albin
authors.initials: A
authors.lastname: Leong
authors.forename: Michael S
authors.initials: MS
authors.lastname: Johnson
authors.forename: Guillermo
authors.initials: G
authors.lastname: Mendoza
authors.forename: E Francis
authors.initials: EF
authors.lastname: Cook
mesh_terms: D000328:Adult; D000486:Allergy and Immunology; D001249:Asthma / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D015272:Pulmonary Medicine; D013038:Specialization; D016896:Treatment Outcome