TY - JOUR
T1 - Comparison of quality of care by specialist and generalist physicians as usual source of asthma care for children
AU - Diette, Gregory B.
AU - Skinner, Elizabeth A.
AU - Nguyen, Theresa T.H.
AU - Markson, Leona
AU - Clark, Becky D.
AU - Wu, Albert W.
PY - 2001
Y1 - 2001
N2 - 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. Design. Cross-sectional survey. Setting. Two large managed care organizations in the United States. Participants. A total of 260 parents of children with asthma. Interventions. None. Main Outcome Measures. 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.
AB - 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. Design. Cross-sectional survey. Setting. Two large managed care organizations in the United States. Participants. A total of 260 parents of children with asthma. Interventions. None. Main Outcome Measures. 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.
KW - Asthma
KW - Guidelines
KW - Pediatrics
KW - Quality of care
KW - Specialist
KW - Usual source of care
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U2 - 10.1542/peds.108.2.432
DO - 10.1542/peds.108.2.432
M3 - Article
C2 - 11483811
AN - SCOPUS:0034891528
SN - 0031-4005
VL - 108
SP - 432
EP - 437
JO - Pediatrics
JF - Pediatrics
IS - 2 II
ER -