Special article
Effects of physician-related factors on adult asthma care, health status, and quality of life

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Abstract

Purpose

To study the association of physician characteristics, the characteristics of their practice settings, patient mix, and reported frequency of prescribing asthma medication with patients’ health status and health-related quality of life in asthma.

Methods

We conducted a mail-back survey of physicians (n = 147) that included demographic characteristics, practice and training characteristics, and reported prescribing frequencies for common asthma treatments. We also conducted structured telephone interviews with 317 of their patients, assessing demographic characteristics, health status (as measured by the Short Form–12 [SF-12] physical component score), and asthma-specific quality of life (as measured by the Marks questionnaire).

Results

In adjusted analyses, pulmonary specialists were more likely to report using leukotriene modifiers (odds ratio [OR] = 4.7; 95% confidence interval [CI]: 1.2 to 18) and theophylline (OR = 3.0; 95% CI: 1.0 to 9.0) in adult patients with asthma. Working in a practice of >75% health maintenance organization (HMO)– or preferred provider organization (PPO)–insured patients was associated with a lower likelihood of prescribing leukotriene modifiers (OR = 0.1; 95% CI: 0.01 to 0.5). Adjusting for patient demographic characteristics and steroid dependence, physician prescribing tendencies were not associated with patients’ perceived health status or quality of life. Although an HMO- or PPO-predominant practice was associated with better physical health status (mean difference in SF-12 physical component score, 3.1; 95% CI: 0.05 to 6.2; P = 0.05), there was no statistical association with quality of life.

Conclusion

The characteristics of physicians, their practices, and the asthma medication prescribing strategies that they adopt are not strongly associated with patients’ perceived outcomes.

Section snippets

Asthma disability subject enrollment

Patients with asthma were enrolled from the practices of 57 pulmonary specialists and 17 allergy and immunology specialists from 1992 to 1994 and from 34 family practitioners in 1996 14, 15. Physicians were selected randomly from all certified specialists in internal medicine and pulmonology (n = 252), internal medicine and allergy and immunology (n = 40), or family practice (n = 2041) in northern California. Patient eligibility was limited to an age range of 18 to 50 years. Physicians

Results

Most physicians were men who had been in practice for many years (Table 1) ; only 1 in 5 had graduated from medical school within 15 years of the survey. Pulmonary and allergy subspecialists accounted for slightly more than half of those surveyed.

Pulmonary specialty training was associated with the likelihood of being a high-frequency prescriber for each of the medications analyzed, although this was not statistically significant for long-acting beta-agonists (Table 2). Physicians in HMO- or

Discussion

We found that pulmonary physicians were more likely to report being high-frequency prescribers of specific asthma medications, whereas physicians in HMO- or PPO-predominant practices were less likely to be high-frequency prescribers of leukotriene inhibitors. However, these physician characteristics were not associated with patient-reported outcomes of health status or quality of life. In contrast, patient sociodemographic factors were associated with the same outcomes.

There has been

Acknowledgements

The authors thank Stephen Shiboski, PhD, for his input and review of the statistical modeling used in this analysis.

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    Supported by grants from the National Institutes of Health (HL56438 and HL04201), Bethesda, Maryland, and the National Institute for Occupational Safety and Health (OH03480), Centers for Disease Control and Prevention, Atlanta, Georgia.

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