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Physician specialty influences important aspects of pediatric asthma management
Yin Nwe Aung1, Carina Majaesic2, Ambikaipakan Senthilselvan2
1Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Insights
Pediatric allergists and respirologists manage asthma differently than pediatricians, impacting patient outcomes. Specialty influences asthma investigations, diagnoses, and inhaled corticosteroid prescriptions, affecting lung function improvement.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Healthcare Quality Improvement
Background:
- Physician training and specialty significantly impact patient care delivery.
- Asthma management requires a multidisciplinary approach, with varying expertise among pediatric specialists.
Purpose of the Study:
- To compare asthma management strategies and changes in lung function (percentage predicted FEV1) across different pediatric physician specialties.
- To identify how pediatricians, pediatric allergists, and pediatric respirologists manage pediatric asthma patients.
Main Methods:
- Retrospective cohort study of children aged 6+ with asthma, followed from 2009-2012.
- Analysis of investigations, comorbid diagnoses, and prescription patterns (inhaled corticosteroids) by physician specialty.
- Multivariate regression to assess specialty differences in inhaled corticosteroid use and FEV1 change.
Main Results:
- Pediatric allergists performed more allergy testing and were more likely to diagnose allergic rhinitis and prescribe nasal steroids.
- Pediatricians were less likely to prescribe inhaled corticosteroids (ICS) compared to pediatric allergists, especially in children with normal lung function.
- Patients managed by pediatric allergists showed greater improvement in FEV1 compared to those seen by pediatricians and pediatric respirologists.
Conclusions:
- Physician specialty significantly influences asthma management decisions, including investigations, diagnoses, and treatment with ICS.
- Areas with more clinical discretion, such as managing children with normal lung function, show the greatest impact of physician specialty.
- Findings have implications for optimizing asthma care guidelines and patient-level management within pediatric subspecialties.
Background:
Physician training influences patient care.
Objective:
To compare asthma management and change in the percentage predicted FEV1 among pediatric physician specialties.
Methods:
A retrospective cohort of children 6 years of age or older, seen in a multidisciplinary asthma clinic between 2009 and 2010, and followed to 2012, was completed to examine differences in asthma outcomes by specialty (2 pediatricians, 3 pediatric allergists, 5 pediatric respirologists). Univariate analyses compared investigation, including allergy testing (skin prick or RAST), comorbid conditions, and prescription by specialty. Multivariate regression, which controlled for random effect of the individual physician, examined specialty differences for prescribed inhaled corticosteroids (ICS) and changes in percentage predicted FEV1.
Results:
More than 56% of the patients (309/548) were seen by pediatric respirologists, 26% by pediatric allergists, and 18% by pediatricians. Physician specialty influences investigation requested, comorbid diagnoses, treatment, and improvement in FEV1. Pediatric allergists' patients had more allergy tests, were more likely to be diagnosed with allergic rhinitis and, consequently, were more likely to be prescribed nasal steroids than pediatricians and pediatric respirologists. Pediatricians were less likely to prescribe ICS (odds ratio 0.39 [95% CI, 0.15-0.96]; P < .05) than pediatric allergists, with the greatest difference in ICS prescription among children with a percentage predicted FEV1 ≥ 80%. Improvement in FEV1 among children who received care with pediatric allergists was higher than those seen by pediatricians (13%; P < .001) and pediatric respirologists (8%; P = .005).
Conclusions:
Patient management domains with the greatest room for discretion (investigations, comorbid diagnoses, and treatment with ICS among children with normal lung function) are most heavily influenced by physician specialty. These results have implications for asthma management at the patient level and in future practice guidelines.
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