A preliminary retrospective treatment and pharmacoeconomic analysis of XXXX care provided by allergists, immunologists, and primary care physicians in a teaching hospital.

@entity1 @entity748 @entity2544 @entity2023 @entity13265 @entity565 @entity1200 @entity4207 @entity10453 @entity288
@entity1200 ( @entity1200 ) differ from primary care physicians (PCP) in their treatment of @entity565 . A limited retrospective chart review of several visits over a 1-year period in 1997 evaluating the quality of @entity565 care by @entity1200 vs. PCPs was conducted in an @entity4207 center. Data concerning quality, effectiveness and cost of @entity565 care was randomly collected from 15 @entity1200 and 15 PCPs from charts at 3-month intervals over a 1-year period. Information obtained from data collection forms revealed that @entity565 @entity1 evaluated by @entity1200 had more visits and received a greater quantity of medication compared to those treated by PCPs. All 15 @entity1 with persistent @entity565 followed by @entity1200 were treated with inhaled corticosteroids at each visit in contrast to only 80% of those treated by PCPs. The total numbers of controller medications (i.e., inhaled @entity288 , @entity10453 , cromolyn, and @entity2544 ) that were utilized, as recommended, by the National Asthma Expert Panel (NAEP) of the National Heart, Lung, and Blood Institute (NHLBI) guidelines were 70 by @entity1200 vs. 24 by PCPs over three visits. Cromolyn was prescribed five times over three visits by @entity1200 and not at all by PCPs. Recognition and treatment of coexisting @entity2023 was evident in only 13% of @entity1 treated by PCPs as compared to 80% in those treated by AIS. (p < 0.0001). However, all @entity1 treated by @entity1200 were skin tested to explore the presence of allergic triggers, while no @entity1 treated by PCPs were evaluated for IgE-mediated reactions. Treatment cost for @entity2023 was therefore higher, at  2039, for @entity1200 as compared to  741 for PCPs. There were no peakflow values in charts obtained from PCPs. However, all charts from @entity1200 had peakflow values, which improved during the course of therapy in 33% of @entity1 . Total medication costs for @entity565 were higher for @entity1200 @  5,646.30 vs.  1,932.25 for PCPs. Total medication costs for @entity2023 plus @entity565 were higher for @entity1200 @  7615 vs.  2681 for PCPs. However, @entity1 treated by @entity1200 had more severe @entity565 and required more frequent visits. @entity13265 was prescribed a total of four times over several visits by PCPs vs. only once by @entity1200 . In comparing @entity565 care between AI specialists and PCPs, it was found that AI specialists treat more severe @entity748 , provide more frequent follow-up visits, utilize peak flow rates, prescribe more controller medications, and more often recognize and treat comorbid conditions such as @entity2023 that impact on @entity565 care. Thus, although treatment costs for @entity1200 are higher, these costs are justified by a quality of care that is more consistent with national (NHLBI) guidelines.
