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

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.