Asthma care specialists improve outcomes
Asthma care specialists improve outcomes
Recent studies show allergists’ value
New information on the positive role specialized care can play in the treatment of asthma is now available to health care professionals, third-party payers, and health plan administrators.
The Role of the Allergist in Cost-Effective Treatment of Asthma, a booklet produced by the Arlington Heights, IL-based American College of Allergy, Asthma & Immunology (ACAAI), provides abstracted and summarized data from 21 recent studies documenting that the involvement of allergists in asthma care achieves better outcomes and cost savings.
The level and type of medical professional treating patients with asthma has important implications in today’s cost-sensitive environment. According to the booklet, asthma in the United States annually accounts for 10.4 million physician visits; 468,000 hospitalizations, 1.8 million emergency department (ED) visits, 3 million lost work days, and 10 million missed school days.
Without effective intervention, these numbers could easily grow. According to data from the Centers for Disease Control and Prevention in Atlanta, there was a 61% increase in the asthma rate between 1982 and 1994. Meanwhile, the American Lung Association estimates that some 14.6 million persons currently suffer from this chronic respiratory disease. Among chronic illnesses in children, according to the Lung Asso ciation, asthma is the most common, with approx imately 33% of all asthma patients younger than 18.
"There is an increasing incidence of asthma, and no one really knows the exact reasons behind this," says Stanley Fineman, MD, co-chairman of the Practice Parameters Committee of ACAAI, from his offices at the Atlanta Allergy Clinic. At the same time, "A number of studies show that allergists can improve the outcomes of patients with asthma," he notes. In a health care marketplace where the use of specialists can be a source of contention, "We put The Role of the Allergist together to provide third-party payers with data to take into consideration when making referral decisions," he says.
Highlights show dramatic improvements
Major highlights gleaned from various studies cited in The Role of the Allergist include:
Fewer hospitalizations/shorter stays. Hospitalizations were reduced by as much as 67%, and the average length of stay declined from 4 days to 2.5 days, when patients with moderate to severe asthma were seen by an allergist, according to one study. Patients who receive care from an asthma specialist also had 63% fewer return visits to the hospital. Fewer ED visits. Patients who receive asthma care from an allergist were found to have fewer ED visits to treat uncontrolled asthma attacks. Meanwhile, patients referred to specialists after visiting an ED with acute asthma symptoms experienced 50% fewer asthma relapses requiring an ED visit. Fewer sick care office visits. A managed care study in Denver found sick care office visits were reduced by 45% in asthma patients who received follow-up care by an allergist for at least one year. Fewer missed work/school days. According to one study cited, patients treated by an allergist had half as many lost work and school days. Another study found that pediatric patients supervised by asthma specialists in a comprehensive home and ambulatory program missed 33% fewer school days than patients not enrolled in the program. Cost savings. Aggressive treatment, with management and care by an asthma specialist, has been shown to dramatically reduce the cost of inpatient care by as much as 95%, according to one study cited. And a study involving patients enrolled in an asthma disease management program showed respective decreases of 78% and 73% in hospitalizations and ED visits, respectively, saving an estimated $2,714 per patient.The Role of the Allergist cites several studies in providing reasons why allergists achieve the most cost-effective outcomes when treating asthma patients.
"As early as 1992, the consensus on treatment was to begin therapy conservatively, introducing one asthma medication at a time and stepping up dosages only when the condition worsened," the booklet states.
Newer evidence-based guidelines, however, recommend aggressive treatment from the onset of symptoms. "The disease should be aggressively treated, with multiple drugs if necessary, to control symptoms as soon as they appear," according to the booklet. "Allergists, with their extensive experience in using these drugs, are the best able to proscribe them properly," adds the booklet.
A recent study by a managed care pharmaceutical benefits company, according to The Role of the Allergist, found that "the best managers of asthma are specialists who tend to be very aggressive with drugs and the use of ancillary supplies such as peak flow meters and nebulizers." Although specialists deployed the most resources in terms of office time and procedures, the study found that "the overall cost savings are very compelling."
[For more information, contact:
• Centers for Disease Control, 1600 Clifton Road, N.E., Atlanta, GA 30333. Telephone: (404) 639-3311. Web site: www.cdc.gov.
• The American Lung Association, 1740 Broadway, New York, NY 10019. Telephone: (800) 586-4872. Web site: www.lungusa.org.
The Role of the Allergist in Cost-Effective Treatment of Asthma is available free of charge in single copies. Contact ACAAI, 85 W. Algonquin Road, Suite 550, Arlington Heights, IL 60005- 4425. Telephone: (847) 427-1200. Fax: (847) 427-1294.]
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