Impact of type of health care provider on long term asthma control

Figures & data

Table 1. Demographic and clinical characteristics.

`	Total (N = 471)	Physician (n = 217, 46%)	APN (n = 254, 54%)
	n (%)	n (%)	n (%)	p
Gender				.523
Male	283 (60.1)	127 (44.9)	156 (55.1)
Female	188 (39.9)	90 (47.9)	98 (52.1)
Family h/o Asthma	347 (73.7)	163 (47)	184 (53)	.511
Smoking exposure	125 (26.5)	51 (40.8)	74 (59.2)	.168
Pet at home	258 (54.8)	114 (44.2)	144 (55.8)	.366
Race/Ethnicity				.560
Caucasian	314 (66.7)	141 (44.9)	173 (55.1)
African American	126 (26.8)	59 (46.8)	67 (53.2)
Hispanic	31 (6.6)	17 (54.8)	14 (45.2)
Asthma severity				.244
Mild persistent	106 (22.5)	47 (44.3)	59 (55.7)
Moderate persistent	324 (68.8)	146 (45.1)	178 (54.9)
Severe persistent	41 (8.7)	24 (58.5)	17 (41.5)
	Mean ± SD	Mean ± SD	Mean ± SD	p
Age at first visit (years)	6.4 ± 2.4	6.4 ± 4.1	6.4 ± 4.1	.741
Age at diagnosis (years)	2.4 ± 4.1	2.5 ± 2.7	2.3 ± 2.2	.660
Duration of symptoms (years)	4.1 ± 3.5	4.2 ± 3.6	4.0 ± 3.3	.500

Table 2. Asthma acute care indicators at baseline and across follow-up period.

	Baseline (n = 471)	3 months	6 months	1 year (n = 396)	2 year (n = 257)	3 year (n = 176)	Change in total cohort over time	Difference between change over time between groups
	Mean ± SD						$\mathit{Wald}\mathrm{ }\chi$ ^2 (p)^1	$\mathit{Wald}\mathrm{ }\chi$ ^2 (p)^2
Mean number of short courses of oral steroids/patient
Total sample	2.7 ± 2.9	0.3 ± 0.7	0.2 ± 0.5	0.4 ± 0.7	0.4 ± 0.7	0.5 ± 0.7	6.049 (.014)*
Physician	3.1 ± 3.2	0.3 ± 0.8	0.2 ± 0.5	0.4 ± 0.7	0.4 ± 0.7	0.5 ± 0.8
APN	2.3 ± 2.6	0.2 ± 0.5	0.2 ± 0.5	0.4 ± 0.7	0.4 ± 0.6	0.4 ± 0.6
p^3	.002*	.099	.816	.651	.874	.370		10.904^3 (.001)*
Mean number of hospital admissions/patient
Total sample	0.5 ± 1.0	.05 ± 0.3	.05 ± 0.3	.05 ± 0.3	.05 ± 0.2	.07 ± 0.3	3.699 (.054)
Physician	0.5 ± 1.0	.07 ± 0.4	.06 ± 0.4	.03 ±.02	.02 ± 0.1	.06 ±.0.2
APN	0.5 ± 1.1	.04 ± 0.2	.04 ± 0.2	.06 ±.03	.08 ± 0.3	.09 ± 0.3
p^3	.592	.354	.601	.263	.060	.403		.078 (.780)
Mean number of emergency room visits/patient
Total sample	1.7 ± 2.7	0.1 ± 0.5	0.1 ± 0.4	0.2 ± 0.5	0.3 ± 0.9	0.2 ± 0.5	6.843 (.009)*
Physician	1.8 ± 3.1	.17 ± 0.5	0.1 ± 0.3	0.2 ± 0.5	0.3 ± 1.1	0.2 ± 0.4
APN	1.6 ± 2.3	0.1 ± 0.3	0.1 ± 0.4	0.2 ± 0.4	0.2 ± 0.6	0.2 ± 0.6
p^3	.293	.191	.555	.858	.553	.484		1.460 (.227)
Mean number of urgent care visits/patient
Total sample	1.5 ± 2.9	0.1 ± 0.4	0.1 ± 0.4	0.2 ± 0.5	0.2 ± 0.5	0.2 ± 0.7	6.652 (.010)*
Physician	1.7 ± 3.4	0.1 ± 0.9	0.1 ± 0.5	0.2 ± 0.5	0.2 ± 0.1	0.3 ± 0.7
APN	1.3 ± 2.5	0.1 ± 0.3	0.1 ± 0.3	0.1 ± 0.6	0.3 ± 0.7	0.2 ± 0.6
p^3	.085	.067	.668	.667	.094	.465		5.181 (.023)*
Mean number of unscheduled primary care visits for acute asthma/patient
Total sample	4.4 ± 5.7	0.3 ± 0.7	0.2 ± 0.5	0.3 ± 0.7	0.4 ± 0.7	0.5 ± 0.8	4.520 (.034)*
Physician	5.7 ± 5.1	0.3 ± 0.9	0 ± 0.6	0.4 ± 0.8	0.4 ± 0.8	0.5 ± 0.8
APN	3.3 ± 5.9	0.2 ± 0.5	0 ± 0.5	0.3 ± 0.6	0.4 ± 0.6	0.4 ± 0.9
p^3	<.001*	.015*	.387	.380	.984	.890		7.658 (.006)*

$\text{Wald χ}$² (p)¹ = significance of changes in asthma acute care indicators over time of the total sample.

$\text{Wald χ}$² (p)² = significance of the difference in asthma acute care indicators between groups over time.

p³ = significance of the difference in asthma acute care indicators between groups at a single time point (at baseline, 3-month, 6-month period etc.).

*Alpha level of significance ≤ 0.05.

Table 3. Asthma symptom at baseline and across follow-up period.

	Baseline (n = 471)	3 months	6 months	1 year (n = 396)	2 years (n = 257)	3 years (N = 176)	Change in total cohort over time	Difference between change over time between groups
Days/month	Mean ± SD						$\mathit{Wald}\mathrm{ }\chi$ ^2 (p)^1	$\mathit{Wald}\mathrm{ }\chi$ ^2 (p)^2
School days missed (days/month)
Total	5.5 ± 7.6	0.7 ± 2.3	0.6 ± 2	0.8 ± 1.7	1 ± 1.9	1.5 ± 2.4	5.154 (.023)*
Physician	5.9 ± 8.1	0.8 ± 2.6	0.6 ± 2.0	0.7 ± 1.7	1.1 ± 1.0	1.5 ± 1.6
APN	5.1 ± 7.2	0.7 ± 2.1	0.7 ± 2.0	0.8 ± 1.7	2.0 ± 1.7	1.6 ± 2.6
p^3	.192	.475	.897	.622	.682	.793		2.866 (.090)
Wheezing (days/month)
Total	10 ± 9.3	2.6 ± 4.4	2.6 ± 5	3.1 ± 4.6	3.5 ± 4.7	3.3 ± 3.6	11.339 (.001)*
Physician	10.8 ± 9.7	2.1 ± 2.8	2.5 ± 4.8	2.8 ± 3.6	3.1 ± 3.5	3.3 ± 4.0
APN	9.3 ± 8.8	3.0 ± 5.4	2.8 ± 5.1	3.3 ± 5.4	3.8 ± 5.6	2.6 ± 2.8
p^3	.083	.038	.518	.307	.230	.937		2.439 (.118)
Nighttime cough (days/month)
Total	11.7 ± 10.4	3.5 ± 5.8	2.9 ± 5.4	3.8 ± 5.5	5.5 ± 6.1	3.4 ± 4.1	9.002 (.003)*
Physician	12.4 ± 12.3	3.3 ± 5.3	2.7 ± 4.8	3.6 ± 4.8	5.1 ± 5.0	3.7 ± 5.0
APN	11.1 ± 10.5	3.6 ± 6.2	3.2 ± 5.9	4.0 ± 6.0	5.8 ± 7.0	3.1 ± 2.8
p^3	.199	.633	.420	.489	.403	.391		1.407 (.235)
Exercise limitations (days/month)
Total	9.1 ± 11.1	2.3 ± 5.6	2 ± 4.8	2.3 ± 5	2.1 ± 3.7	2.3 ± 4.9	6.967 (.008)*
Physician	10.4 ± 11.6	2.1 ± 5.0	2.1 ± 5.5	2.1 ± 3.8	2.0 ± 3.4	2.4 ± 5.7
APN	8 ± 10.6	2.5 ± 6.1	1.8 ± 4.1	2.5 ± 5.8	2.0 ± 4.0	2.1 ± 4.0
p^3	.018*	.416	.487	.505	.967	.713		3.864 (.049*)
Albuterol use (days/month)
Total	10 ± 9.8	3.3 ± 5.9	2.6 ± 5	3.0 ± 4.2	3.3 ± 4.1	3.6 ± 4	6.471 (.011)*
Physician	10.2 ± 10	3.3 ± 0.6	2.1 ± 3.5	2.8 ± 3.8	3.2 ± 4.0	3.6 ± 4.1
APN	9.8 ± 9.6	3.3 ± 0.6	3.1 ± 6.1	3.3 ± 3.6	4.1 ± 4.0	3.5 ± 3.4
p^3	.626	.982	.069	.272	.675	.852		.194 (.659)

$\text{Wald χ}$² (p) ¹ = significance of changes in asthma acute care indicators over time of the total sample.

$\text{Wald χ}$² (p) ² = significance of the difference in asthma acute care indicators between groups over time.

p³ = significance of the difference in asthma acute care indicators between groups at a single time point (at baseline, 3-month, 6-month period etc.).

*Alpha level of significance ≤ 0.05.

Table 4. Asthma control test scores and mean %predicted FEV1 at baseline and across follow-up period.

	Baseline	3 months	6 months	1 year	2 years	3 years	Change in total cohort over time	Difference between change over time between groups
	Mean ± SD						$\mathit{Wald}\mathrm{ }\chi$ ^2 (p)^1	$\mathit{Wald}\mathrm{ }\chi$ ^2 (p)^2
Asthma control test (ACT) score
	n = 382			n = 306	n = 187	n = 128
Total	15.9 ± 5.7	20.3 ± 4.9	21 ± 4.7	21.2 ± 4.2	21.3 ± 4.5	21.9 ± 4	11.577 (.001)*
Physician	16 ± 5.3	20.4 ± 5.0	21.4 ± 4.6	21.8 ± 3.7	22.1 ± 3.8	21.7 ± 4.1
APN	16 ± 6	20.3 ± 4.8	20.5 ± 4.8	20.4 ± 4.6	20.5 ± 4.9	22 ± 3.9
p^3	.756	.882	.211	.027*	.022*	.708		.081 (.776)
Mean % predicted FEV1
	n = 326			n = 248	n = 158	n = 106
Total	93 ± 17	98 ± 15	96 ± 15	98 ± 17	9 ± 15	102 ± 15	.192 (.661)
Physician	93 ± 17	98 ± 15	99 ± 16	101 ± 14	97 ± 14	103 ± 14
APN	92 ± 17	98 ± 16	94 ± 15	96 ± 18	9 ± 16	101 ± 15
p^3	.702	.835	.211	.146	.969	.591		1.944 (.163)

$\text{Wald χ}$² (p)¹ = significance of changes in asthma acute care indicators over time of the total sample.

$\text{Wald χ}$² (p)² = significance of the difference in asthma acute care indicators between groups over time.

p³ = significance of the difference in asthma acute care indicators between groups at a single time point (at baseline, 3-month, 6-month period etc.).

*Alpha level of significance ≤ 0.05.

Table 5. Demographic and clinical characteristics of patients followed for the duration of the study vs. those who were lost to follow-up.

	Total (N = 471)	Patients completing 3-year follow-up (n = 176, 37%)	Patients lost to follow-up (n = 295, 63%)
	n (%)	n (%)	n (%)	p
Gender				.178
Male	283 (60.1)	112 (39.5)	171 (60.5)
Female	188 (39.9)	67 (39.6)	121 (64.4)
Family h/o Asthma	347 (73.7)	125 (36)	222 (64)	.375
Smoking exposure	125 (26.5)	50 (40)	75 (60)	.428
Pet at home	258 (54.8)	103 (40)	155 (60)	.870
Race/Ethnicity				.016*
Caucasian	314 (66.7)	113 (36)	201 (64)
African American	126 (26.8)	62 (49)	64 (51)
Hispanic	31 (6.6)	16 (52)	15 (48)
Asthma severity				<.001*
Mild persistent	106 (22.5)	10 (9.5)	96 (90.5)
Moderate persistent	324 (68.8)	144 (44.4)	180 (55.5)
Severe persistent	41 (8.7)	36 (88)	5 (12)
Provider				.534
Physician	217 (46%)	80 (37)	137 (63)
APN	(254 (54%)	99 (39)	155 (61)
		Mean ± SD	Mean ± SD	p
Age at first visit (yrs.)	6.4 ± 2.4	6.3 ± 3.9	6.9 ± 4.4	.012*
Age at diagnosis (yrs.)	2.4 ± 4.1	2.2 ± 2	2.7 ± 2.9	.081
Duration of symptoms (yrs.)	4.1 ± 3.5	3.9 ± 3.5	4.3 ± 3.6	.216

*Alpha level of significance ≤ 0.05.

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