We couldn't agree more with Ault's bottom-line assertion that the medical community in the United States, and particularly those of us affiliated with large managed care organizations, need to be encouraging an appropriate partnering of specialty care with primary care for the management of asthma (and other chronic health conditions). It was not our intent to suggest that specialty care should replace primary care for the management of asthma. The real challenge for managed care, as we see it, is determining how best to integrate specialty referrals into the fabric of care for asthma. For example, which patients are most likely to benefit from specialist referral, who should continue to receive ongoing specialist care vs primary care for asthma, and what is the benefit of integrating nonphysician chronic disease specialists, such as specially trained licensed practical nurses or physician assistants, into primary care clinics as an intermediary between primary care and specialty care? Some guidance is provided by the newly revised national Guidelines for the Diagnosis and Management of Asthma,1 which gives recommendations to help clarify which patients with asthma need to be evaluated by a specialist.
Vollmer WM, Ettinger KM, Stibolt T. Subspecialty Systems for Primary Care Providers: A New Alliance. Arch Intern Med. 1998;158(5):542. doi: