Real-World Assessment of Asthma Specialist Visits Among US Patients with Severe Asthma
Real-World Assessment of Asthma Specialist Visits Among US Patients with Severe Asthma
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DOI：
10.1016/j.jaip.2021.05.003
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发表时间：
2021-10-06
影响因子：
9.4
通讯作者：
Zhao, Xiaohui
中科院分区：
文献类型：
--
作者：
Most, Jessica F.;Ambrose, Christopher S.;Zhao, Xiaohui
背景：美国指南建议重症哮喘患者转诊给专科医生（过敏症专家/免疫学家或肺科医生）进行系统评估或管理；然而，关于美国重症哮喘患者专科护理的频率和影响的当代真实数据缺乏。目的：量化美国严重哮喘患者的哮喘专科就诊频率，确定与专科就诊相关的患者人口统计学和临床特征，并描述专科治疗后的健康结果。方法：根据医疗有效性数据和信息集（HEDIS）标准和全球哮喘倡议（GINA）第4步或第5步治疗方案，在IQVIA PharMetrics (R) Plus商业参保个人数据库中确定2015年1月1日至2017年12月31日期间6岁或以上的严重哮喘患者。哮喘专科医生（过敏症专科医生/免疫学家或肺科医生）的就诊频率被描述为超过2年。使用多变量回归分析与1次或1次以上专科就诊相关的患者特征。比较专科就诊前后哮喘加重情况及卫生保健资源利用情况。结果：在确定的54,332例患者中，38.2%的患者在2年内有1次或更多的专科就诊。预测专科就诊的患者特征是哮喘发作频率、年龄较小和过敏/呼吸合并症负担（均P < 0.001）。在1次或1次以上专科就诊的患者中，在第一次专科就诊后，观察到哮喘加重和抢救吸入器使用的患病率较低。结论：专科护理在不到一半的美国严重哮喘患者中被观察到，在老年患者和非呼吸合并症患者中最不常见。增加专家参与管理严重哮喘可能有助于改善护理和患者的结果。(C) 2021作者。由爱思唯尔公司代表美国过敏、哮喘和免疫学学会出版。
BACKGROUND: U.S. guidelines recommend that patients with severe asthma be referred to specialists (allergists/immunologists or pulmonologists) for systematic assessment or comanagement; however, contemporary, real-world data on the frequency and impact of specialist care among U.S. severe asthma patients are lacking.OBJECTIVES: To quantify the frequency of asthma specialist visits among U.S. patients with severe asthma, identify patient demographic and clinical characteristics associated with specialist visits and describe health outcomes following specialist care.METHODS: Severe asthma patients aged 6 years or older were identified between January 1, 2015, and December 31, 2017, in the IQVIA PharMetrics (R) Plus database of commercially insured individuals, based on Healthcare Effectiveness Data and Information Set (HEDIS) criteria and Global Initiative for Asthma (GINA) step 4 or 5 treatment regimens. The frequency of asthma specialist (allergist/immunologist or pulmonologist) visits was described over 2 years. Patient characteristics associated with having 1 or more specialist visits were analyzed using multivariate regressions. Asthma exacerbations and health care resource utilization before and after specialist visit were compared.RESULTS: Of 54,332 patients identified, 38.2% had 1 or more specialist visits over 2 years. Patient characteristics predictive of specialist visits were asthma exacerbation frequency, younger age, and allergy/respiratory comorbidity burden (all P < .001). Among patients with 1 or more specialist visits, a lower prevalence of asthma exacerbations and rescue inhaler use was observed following the first observed specialist visit.CONCLUSIONS: Specialist care was observed in fewer than half of U.S. patients with severe asthma and was least frequent among older adult patients and those with more nonrespiratory comorbidities. Increased specialist involvement in managing severe asthma may help improve care and patient outcomes. (C) 2021 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.