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PEDIATRICS Vol. 108 No. 2 August 2001, pp. 432-437

Comparison of Quality of Care by Specialist and Generalist Physicians as Usual Source of Asthma Care for Children

Received Dec 7, 2001; accepted Apr 11, 2001.

Gregory B. Diette*, Dagger , Elizabeth A. Skinner§, Theresa T. H. NguyenDagger , Leona Marksonparallel , Becky D. Clark§, and Albert W. WuDagger , §,

From the * Division of Pulmonary and Critical Care Medicine, School of Medicine; Dagger  Department of Epidemiology, School of Hygiene and Public Health; § Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland; parallel  Merck & Co, Inc, West Point, Pennsylvania; and  Division of General Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.

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.  Key words:  asthma, pediatrics, specialist, usual source of care, quality of care, guidelines.


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