title: Physician specialty influences important aspects of pediatric asthma management.
abstract: BACKGROUND
  Physician training influences patient care.
  
  
  OBJECTIVE
  To compare asthma management and change in the percentage predicted FEV1 among pediatric physician specialties.
  
  
  METHODS
  A retrospective cohort of children 6 years of age or older, seen in a multidisciplinary asthma clinic between 2009 and 2010, and followed to 2012, was completed to examine differences in asthma outcomes by specialty (2 pediatricians, 3 pediatric allergists, 5 pediatric respirologists). Univariate analyses compared investigation, including allergy testing (skin prick or RAST), comorbid conditions, and prescription by specialty. Multivariate regression, which controlled for random effect of the individual physician, examined specialty differences for prescribed inhaled corticosteroids (ICS) and changes in percentage predicted FEV1.
  
  
  RESULTS
  More than 56% of the patients (309/548) were seen by pediatric respirologists, 26% by pediatric allergists, and 18% by pediatricians. Physician specialty influences investigation requested, comorbid diagnoses, treatment, and improvement in FEV1. Pediatric allergists' patients had more allergy tests, were more likely to be diagnosed with allergic rhinitis and, consequently, were more likely to be prescribed nasal steroids than pediatricians and pediatric respirologists. Pediatricians were less likely to prescribe ICS (odds ratio 0.39 [95% CI, 0.15-0.96]; P < .05) than pediatric allergists, with the greatest difference in ICS prescription among children with a percentage predicted FEV1 ≥ 80%. Improvement in FEV1 among children who received care with pediatric allergists was higher than those seen by pediatricians (13%; P < .001) and pediatric respirologists (8%; P = .005).
  
  
  CONCLUSIONS
  Patient management domains with the greatest room for discretion (investigations, comorbid diagnoses, and treatment with ICS among children with normal lung function) are most heavily influenced by physician specialty. These results have implications for asthma management at the patient level and in future practice guidelines.
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Yin Nwe
authors.initials: YN
authors.lastname: Aung
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Carina
authors.initials: C
authors.lastname: Majaesic
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Ambikaipakan
authors.initials: A
authors.lastname: Senthilselvan
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada. Electronic address: mandhane@ualberta.ca.
authors.forename: Piushkumar J
authors.initials: PJ
authors.lastname: Mandhane
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000486:Allergy and Immunology / Q000706:statistics & numerical data; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D015331:Cohort Studies; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects / Q000502:physiology; D006801:Humans; D008297:Male; D008511:Medicine / Q000379:methods* / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000379:methods / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012882:Skin Tests / Q000706:statistics & numerical data
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents
keywords: Asthma; Inhaled corticosteroids; Pediatrics; Physician training; Spirometry