title: Quality of care in patients with asthma and rhinitis treated by respiratory specialists and primary care physicians: a 3-year randomized and prospective follow-up study.
abstract: BACKGROUND
  Previous studies evaluating asthma care provided by primary care providers and respiratory specialists (RSs) are limited by short observation periods and nonrandomized designs.
  
  
  OBJECTIVE
  To evaluate long-term outcomes in patients with asthma and rhinitis randomly selected to be cared for by RSs or primary care specialists.
  
  
  METHODS
  In a randomized, 3-year, longitudinal study, 472 patients with asthma and allergic rhinitis were cared for by RSs or primary care physicians. Outcome measures, including disease severity, lung function, medication use, compliance, and self-management knowledge, were compared between groups.
  
  
  RESULTS
  Compared with patients followed up by primary care providers, those in the RS group had reduced asthma severity (P = .046), significantly fewer days with asthma symptoms (P < .01), and improved asthma self-management knowledge (P < .01). At baseline, most patients were undertreated. This value was significantly reduced from 74% to 37% in the RS group and from 71% to 57% in the primary care physician group. We found odds ratios of 8.5 (95% confidence interval, 2-43; P < .01) for worsening of asthma and 0.3 (95% confidence interval, 0.1-0.9; P = .04) for asthma improvement when followed up by primary care physicians, which indicates that primary care follow-up increases the risk of worsening of asthma and decreases the chance of improving. Similar results were observed in patients with allergic rhinitis, although the findings were less pronounced.
  
  
  CONCLUSIONS
  Treatment and follow-up by an RS ensured better quality of care in patients with asthma and rhinitis.
authors.affiliation: Respiratory and Allergy Research Unit, Department of Internal Medicine, University Hospital of Copenhagen, H:S Bispebjerg Hospital, Copenhagen, Denmark. backer@dadlnet.dk
authors.forename: Vibeke
authors.initials: V
authors.lastname: Backer
authors.forename: Steen
authors.initials: S
authors.lastname: Nepper-Christensen
authors.forename: Hendrik
authors.initials: H
authors.lastname: Nolte
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000628:therapy*; D005194:Family Practice / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D015272:Pulmonary Medicine / Q000592:standards*; D011787:Quality of Health Care; D012220:Rhinitis / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome