Transcript AAOHNS Fri PM/Sat 2001 POWERPOINT SLIDES

Asthma
Management
and the Allergist:
Better Outcomes
at Lower Cost
Asthma Patients
Cared for by Allergists Have:
• Fewer emergency care visits
• Fewer
hospitalizations
• Reduced length
of hospital stays
Asthma Patients
Cared for by Allergists Have:
• Fewer sick care office visits
• Fewer days missed –
school and work
Fewer sick
days =
Increased
productivity
in work and
personal lives
Asthma Patients
Cared for by Allergists Have:
• Greater satisfaction
with their care
• Improved quality
of life
• Better overall
outcomes that
lower costs
Asthma in the United States
• 22 million Americans
• 6.5 million children
• 14.7 million physician visits
• 1.8 million ER visits
• 497,000 hospitalizations
Direct and Indirect
Costs of Asthma Care
Direct Medical Costs
Hospital Care: Inpatient and ER
Physician Services
Pharmaceuticals
Indirect Medical Costs
Decreased worker productivity
(lost work and school days)
Total Direct and Indirect Costs
$4.7 B
$3.8 B
$6.2 B
$5.0 B
$19.7 B
Setting Standards of Care
According to Guidelines, people with asthma
should expect:
• No or few asthma symptoms
• Prevention of all or most asthma attacks
• Participation in all activities
• No ER visits or hospital stays
• Less need for quick-relief meds
• No or few side effects from asthma meds
Compliance with Guidelines is Poor
One multicenter study of 4,000 patients found:
• 83% had uncontrolled asthma
• 16% had inconsistent control
• 1.3% were controlled
Cost per patient per year
Compliance with Guidelines is Poor
Compliance with Guidelines is Poor
Asthma uncontrolled in 85% of inner-city
students with asthma
• 50% had been treated in ER at least twice in
previous two years
• 52% often had to limit activities
• 29% had nighttime symptoms once or more
per week
• 17% missed five or more days of school per
year because of asthma
Compliance with Guidelines is Poor
Analysis of 24,000 Medicaid patients found nonadherence to NIH Guidelines :
• Fewer than 40% received rescue medication
• Fewer than 10% were regular users of inhaled
corticosteroids
When to Refer to An Allergist
Patients should be referred to a specialist if they:
•Have symptoms every day and often at night
•Have had life-threatening attack
•Do not meet treatment goals in 3-6 months
•Have unusual/hard-to-diagnose symptoms
•Have co-existing conditions
•Need additional tests
•Need more help and instruction
When to Refer to An Allergist
Patients should be referred to a specialist if they:
•Might be helped by allergy shots
•Need oral or high-dose inhaled corticosteroids
•Use oral corticosteroids 2+ times/year
•Have been hospitalized for asthma
•Need help to identify asthma triggers
•Are children age 0-4 with frequent symptoms
PCP Referral Patterns Often
Differ from Guidelines
• Survey of pediatricians and family physicians found
criteria for referral did not conform to Guidelines
• Study of PCPs found those who had training in
allergic diseases were more likely to refer than
those who were not as educated (78% vs. 46%)
Allergists and NIH Guidelines
In a survey of 1,954 patients in 12 MCOs,
patients cared for by allergists reported:
• Fewer hospitalizations and ER visits
• Higher ratings for quality of care
• Fewer activity restrictions
• Improved physical functioning
Asthma Treatment Outcomes
• Fewer hospitalizations
• Fewer ER visits and sick care office visits
• Improved patient satisfaction and QOL
Number of Hospitalizations
Asthma Treatment Outcomes –
497,000 Hospitalizations
Asthma Treatment Outcomes –
1.8 Million ER Visits
• Study of 9,500+ HMO patients documented lower
risk of emergency asthma care with specialty care
• Randomized study of 2,000 children found patients
seeing allergist were only 54% as likely to require
ER services
• Comprehensive treatment
in specialty allergy center
reduced ER visits
76%
Number of Visits
Asthma Treatment Outcomes –
14.7 Million Sick Care Visits
Asthma Treatment Outcomes –
Number of Lost Days
10 Million Lost Work Days
13 Million Lost School Days
Asthma Treatment Outcomes –
Patient Satisfaction and QOL
• Patients who receive care from allergist are
more satisfied and experience improved
emotional and physician well-being
• Study of 400 HMO patients saw improvements
in physical function, emotion, pain relief and
general health
• Patients in private practice reported
improvements in ability to participate in
activities, emotional well-being and asthma
control
Asthma Treatment Costs
• Studies show aggressive allergist management
produces better outcomes AND reduces costs
• Specialty center experienced a 45% to 80%
reduction in insurance claims
• AAFA study found 54% increase in cost of care
when guidelines are not followed
• Failure to control asthma carries high price with
80% of all resources expended used by 20% of
patients with uncontrolled disease
Inpatient Care Costs
Asthma Treatment Costs –
$4.7 Billion in Hospitalizations
ER Costs
Asthma Treatment Costs –
$546 Million in ER Visits
How Allergists Improve
Outcomes, Lower Costs
• Accurately diagnose disease types and severity
• Identify external triggers including allergens and
advise on avoidance
• Administer immunotherapy (allergy shots) to
decrease sensitivity to allergic triggers
• Develop and implement
aggressive treatment plans
• Maintain disease control
• Prevent serious consequences
Aggressive Asthma Management –
The Standard of Care
• Guidelines recommend early diagnosis and
aggressive treatment
• Treatment to control symptoms – initiate at onset
and step down with improvement
• Significant long-term benefits and cost
savings outweigh high costs of
initial therapy
Emerging Role of New Treatments
and Prevention
• Allergists aware of latest treatment and control
strategies
o
Environmental pollutant and allergens
o
Self-management and trigger avoidance
o
Partnerships with health care providers,
families and other caregivers
o
Immunotherapy specialists
o
Clinical trial participants
Specialty Care of Asthma in
Health Plans
• Asthma management a model for the new
strategy of managed care
• NCQA has made appropriate management of
asthma a key indicator in evaluating the
quality of health plans
• PCPs are demanding greater say in referring
patients to specialists
Specialty Care of Asthma in
Health Plans
ACAAI provides health plan checklist:
• Access to specialists
• Ongoing management for
specialist care
• Unlimited visits
• Access to tests
• Access to medications and shots
• Management by specialist without
high co-payments
Asthma Management and
the Allergist:
Better Outcomes at
Lower Cost
Documented by an evidence-based
review of the literature
For a copy of the review, including an
annotated bibliography, go to:
www.acaai.org