Patient Referrals to a Multispecialty Asthma Clinic

Abstract

A total of 656 patients with asthma have been referred to a multispecialty pediatric asthma clinic for evaluation; 52 (7.9%): mild; 406 (61.9%): moderate; 177 (27%): severe; and 21 (3.2%): incomplete data. No significant differences in demographics or payer source were observed across disease severity levels. Only 25% of the patients with primary care providers were referred by these practitioners. Over 20% of the mild asthmatics were using inhaled bronchodilators regularly. Only 40% and 50% of the moderate and severe asthmatics, respectively, were using inhaled bronchodilators regularly, and only 19% and 36%, respectively, were on maintenance inhaled corticosteroids. Pressures to reduce subspecialty services may place some of these asthma patients at increased risk for complications from this chronic lung disease.

Dedicated Asthma Center Improves the Quality of Care and Resource Utilization for Pediatric Asthma: A Multicenter Study

“…Asthma severity was classified using self-reported clinical characteristics based on the 1998 NHLBI asthma severity of illness classification. 4,23 Access to care and resource utilization measures are shown in Figure 1, panel B. The AC families were more likely to report having access to a physician to call to assist with outpatient management than the ED controls, 98.2% vs 65% (OR = 25.3; 95% CI = 9.0 to 76.9).…”

“…In a study by James et al, only 40% of patients with moderate persistent asthma and 50% of patients with severe persistent asthma were using bronchodilators regularly and correctly. 23 In the same study, only 19% of moderate and 36% of severe persistent asthmatic patients were taking maintenance inhaled corticosteroids. 23 Factors that were significantly associated with inadequate medication therapy included: age <5 years old, Medicaid insurance, and Spanish language.…”

“…23 In the same study, only 19% of moderate and 36% of severe persistent asthmatic patients were taking maintenance inhaled corticosteroids. 23 Factors that were significantly associated with inadequate medication therapy included: age <5 years old, Medicaid insurance, and Spanish language. 21 Our data are consistent with these prior investigations and reveal significant disparities in quality of care, access to care, ED resource utilization, and functional impact between the patients who were treated by a comprehensive pediatric AC and the patients whose caregivers identified the ED as a primary source of asthma care.…”

“…8 The root cause of this widespread increase in pediatric asthma is multifactorial and has been attributed to socioeconomic 1,5,9,10 and environmental [11][12][13][14][15][16] factors. Additionally, lack of adequate access to health care, [17][18][19] lack of use of appropriate medications, [20][21][22][23] and lack of adequate asthma education 10 have been shown to be significant contributors. In a study by James et al, only 40% of patients with moderate persistent asthma and 50% of patients with severe persistent asthma were using bronchodilators regularly and correctly.…”

Do We Have Time for the Change?

“…In fact, more than 75% of the recommendations in an Agency for Health Care Policy and Research-sponsored guideline on the treatment of pressure ulcers were based on only expert opinion. 15 A few studies [16][17][18] have evaluated the use of clinical guidelines by primary care physicians. A recent meta-analysis 16 showed that little evidence existed to support the contention that the use of guidelines by primary care providers actually improved patient care.…”