Consultation for asthma: results of a generalist survey.

Abstract

There are few studies that examine referral patterns for asthma and few studies that examine the referring physicians' reasons for consultation. The purpose of this study was to survey generalist physicians on their referral patterns for adult patients with asthma. We mailed a questionnaire to all the staff (faculty) in the Department of Family Medicine and the Division of Community Internal Medicine at the Mayo Clinic in Rochester, Minnesota. There were 37 completed questionnaires (18 family medicine and 19 internal medicine) out of a total of 58 for a response rate of 64%. The survey asked what were reasons for consultation, whether allergists or pulmonologists were preferred, and the characteristics of a good consultation. We asked respondents to indicate "how often you consult a specialist for an adult asthma patient" for a variety of clinical indications. The percentage responding "always" (for the top five indications) were if the patient requests one (46%), for allergen immunotherapy (38%), for single life-threatening attack (27%), for allergy testing (14%), and for steroid-dependent asthma or poorly controlled asthma (11%). Twenty-seven percent of respondents generally consulted allergists only, 22% generally consulted pulmonologists only, 3% indicated both, while 46% had no preference. Respondents did express a preference for a pulmonologist when the reported reason for the consultation was diagnosis of asthma uncertain, chronic cough, asthma in smoker, exercise training, or for an allergist when the reported reason for consultation was allergy evaluation or immunotherapy. The respondents indicated that the top six characteristics of a good consultation were the following: clear recommendations, clinically appropriate recommendations, high patient satisfaction, including recommendations for future management scenarios, including educational content in the consultation, and calling the referring physician before requesting a secondary consultation. These results suggest that while consultation occurs often for severe or uncontrolled asthma, some asthma patients who may benefit from consultation may not be seeing the specialist. There were no systematic preferences for consultations with allergists versus pulmonologists for asthma although for some clinical indications pulmonologists or allergists were favored. Referring physicians value clear, clinically appropriate recommendations.