Allergist influence on asthma care.

In 1989, the hospitalization rate for asthma at our institution had increased 23%. To evaluate possible reasons for this we examined all new patients seen in our clinic between June, 1985 and June, 1986. A second assessment of the same patients between June, 1987 and June, 1988 was also performed. Two-hundred nine patients were seen for asthma in 1986. Analyzed by follow-up care provider, care by an allergist (CA), and nonallergist care (NAC), at baseline patients had similar hospitalization (CA = 37%, NAC = 40%) and emergency room (CA = 61%, NAC = 45%) visit rates. At follow-up (1988), there was a significantly higher hospitalization rate in the NAC group (35%) than in the CA group (13%). Emergency room visits during the previous year were also significantly greater in the NAC group (47%) compared with the CA group (18%). Major differences in drug therapy between 1986 and 1988 included a marked increase in the utilization of inhaled corticosteroids and sodium cromolyn in the maintenance therapy of patients followed by an allergist. The use of spacer devices for inhalers and home peak flow meters also increased significantly in the CA group. Oral corticosteroid use increased similarly in both groups. Although there is an overall increase in admissions for asthma at our institution in 1989, these data suggest that continued follow-up care by an allergist is associated with a decreased hospital admission and emergency room visit rates when compared with care given by a generalist.