The effect of generalist and specialist care on quality of life in asthma patients with and without allergic rhinitis.
BACKGROUND
Treatment of asthma and rhinitis patients is often provided by both generalists (GPs) and specialists (SPs). Studies have shown differences in clinical outcomes of treatment between these settings. The aim of this study was to evaluate the effect of GP and SP care on health-related quality of life (HRQoL).


METHODS
Three hundred and eight asthma and allergic rhinitis patients randomized to 3 years' treatment by an SP or GP were examined at baseline and at study completion. At both examinations, the HRQoL was measured with the Standardized Asthma Quality of Life Questionnaire (AQLQ) and the Rhinitis Quality of Life Questionnaire (RQLQ).


RESULTS
In the SP care, a significant improvement from baseline was found in HRQoL for both AQLQ total scores (6.19 +/- 0.1 vs. 6.44 +/- 0.1, respectively; p < 0.001) and RQLQ total scores (0.80 +/- 0.1 vs. 0.58 +/- 0.1, respectively; p <0.01). Patients in the GP care setting experienced no change in HRQoL total scores during the study. However, improvements were found predominantly in patients with concomitant rhinitis. Although no change in AQLQ was found in the GP setting in this group with double disease, an association between change in RQLQ and AQLQ was found (r = -0.245, p < 0.05, and r = -0.324, p < 0.001, respectively).


CONCLUSIONS
The results provide evidence that compared with GP care, SP care leads to an improvement in both asthma and rhinitis quality of life. This is especially pronounced in patients with concomitant asthma and rhinitis and supports the guidelines recommending that SPs should monitor patients with complicated disease.
Department of Lung Medicine L, Copenhagen University Hospital, Bispebjerg, Denmark.
Lotte
L
Harmsen
Hendrik
H
Nolte
Vibeke
V
Backer
D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D011788:Quality of Life; D012129:Respiratory Function Tests; D012221:Rhinitis, Allergic, Perennial / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006255:Rhinitis, Allergic, Seasonal / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D013038:Specialization / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult