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

Ann Allergy Asthma Immunol. 2006 Oct;97(4):490-6. doi: 10.1016/S1081-1206(10)60940-4.


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.

Conclusion: Treatment and follow-up by an RS ensured better quality of care in patients with asthma and rhinitis.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Asthma / therapy*
  • Family Practice / standards*
  • Female
  • Follow-Up Studies
  • Humans
  • Long-Term Care
  • Male
  • Outcome Assessment, Health Care*
  • Prospective Studies
  • Pulmonary Medicine / standards*
  • Quality of Health Care*
  • Rhinitis / therapy*
  • Surveys and Questionnaires
  • Treatment Outcome