The impact of a large-scale population-based asthma management program on pediatric asthma patients and their caregivers.

BACKGROUND: The consequences of pediatric asthma include missed school attendance, limitations in physical activity, and increased health care utilization and costs. Caregivers of asthmatic children are affected through missed work days and decreased job productivity. In response to these issues, a disease management program encompassing asthmatic children and their caregivers was developed as part of the core services offered to members of a large, national health care plan. OBJECTIVE: To determine the impact of the asthma management program on pediatric asthma patients and their caregivers over a 12-month period. METHODS: In this longitudinal study, 401 randomly selected member households with asthmatic children from 17 regional markets completed surveys before and after 12 months of participation in the asthma management program. Program interventions, which were tailored according to risk and need status, included various staggered educational mailings, reminder aids, videos, a peak expiratory flow rate meter, and telephonic case management. The Asthma Quality Assessment System survey, a battery of self-reported quality indicators, was used to solicit information from parents or caregivers of asthmatic children on issues pertaining to quality of life, asthma management skills and knowledge, and lost work/school days related to asthma. RESULTS: Statistically significant postprogram outcomes were observed in various domains, including a reduction in adverse utilization, symptomatology, and restricted activity days for children and lost work days for adult caretakers. CONCLUSIONS: These findings demonstrate that a large-scale population-based intervention program can produce measurable clinical and economic benefits, thereby lessening the burden of asthma on the family unit.

Impact of respiratory symptoms on health-related quality of life and medical resource utilization of patients treated by allergy specialists and primary care providers.

BACKGROUND: Respiratory symptoms associated with allergy and asthma cause substantial health care burden. OBJECTIVE: This observational pilot study compared internal medicine/family practice (IM/FP) and pediatric primary care providers with allergists in the diagnosis, treatment, and health-related quality of life (HRQL) outcomes of adults and children with respiratory symptoms. METHODS: Two allergists, 2 IM/FP, and 2 pediatricians enrolled 242 patients with respiratory symptoms ages 5 to 16 years old (n = 123) and 17 to 70 years old (n = 119). HRQL questionnaires were completed at enrollment and quarterly for 1 year. The adult questionnaire included SF-36, respiratory symptom role productivity, ITG Asthma Short Form, and allergy symptom index (ASI) scales. The child questionnaire included CHQ-PF28, respiratory symptom family impact, ITG Child Asthma Short Form, and ASI scales. HRQL changes were evaluated over the study period. RESULTS: Adults treated by allergists reported significantly greater improvement in HRQL on 5 of 8 SF-36 scales, the respiratory symptom role productivity scale, 3 of 5 ITG Asthma Short Form scales, and 2 of 4 ASI scales compared with adults treated by an IM/FP (P < 0.05). Pediatric patients treated by allergists had significantly greater improvement on 3 of 15 CHQ-PF28 scales, the respiratory symptom family impact scale, and one ASI scale compared with patients treated by pediatricians (P < 0.05). CONCLUSIONS: Compared with patients treated by primary care physicians, patients treated by allergists reported greater improvement in HRQL in a number of scales. Additional research is required to further evaluate the impact of provider specialty and patterns of care on outcomes of respiratory symptoms patients.