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

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.