J ALLERGY CLIN IMMUNOL

FEBRUARY 2013

AB34 AbstractsSATURDAY

123 Comparison of Characteristics of Asthma Patients SeekingCare From Specialists Versus Primary Care Physicians

Kurtis S. Elward, MD1, Thomas B. Casale, MD, FAAAAI2, Wilson

Pace3,Michael Schatz, MD, MS, FAAAAI4, RyanWalters5, Paul Turner5;1American Academy of Family Physicians, Charlottesville, VA,2Creighton University School of Medicine, Omaha, NE, 3U Colorado,

Denver, 4Kaiser Permanente, San Diego, CA, 5Creighton University.

RATIONALE: There is a lack of data comparing the characteristics of

asthma patients seeking care from specialists vs. primary care physicians

(PCPs). We hypothesized that patients seeking care from specialists would

have more uncontrolled/severe disease.

METHODS: We obtained data from unique patient entries into the

Asthma IQ program for 2,614 patients seeing specialists and 270 seeing

PCPs.

RESULTS: Baseline demographic data indicated that specialists’ patients

were older 28.9+22 vs. 8.2+6.4 (p<0.05) and had higher BMIs 24.7+

8.3 vs. 20+6.5 (p<0.05), but similar ethnicity and smoking histories.

Specialists’ patients had higher prevalences of important comorbidities:

rhinosinusitis 47 vs. 23%, p<0.05; GERD 12 vs. 8%; obesity 11 vs. 5%,

p<0.05; and depression 2.1 vs. 0.7%.Guideline severity levels obtained for

500 initial patient visits from specialists and 45 from PCPs were: 47% vs.

60% intermittent; 15% vs. 24%mild, 21% vs. 13% moderate, and 17% vs.

2% severe, respectively (p<0.05). Guideline-driven control levels ascer-

tained for 1565 specialists’ patients and 105 PCPs’ patients were: 63% vs.

60% well controlled; 25% vs. 34% not well controlled, and 12% vs. 6%

poorly controlled, respectively (p<0.05). The mean Asthma Control Test

scores were 21.4+3.8 (n5 1247) for specialists vs. 20.6+4.1(n570) for

PCPs, p50.059. FEV1% predicted values were 87.9+17.9% (n51933) for

specialists’ patients and 93.2+16.5% (n542), p<0.05 for PCPs.

CONCLUSIONS: Although our data are somewhat limited by the low

numbers of patients seen by PCPs, data from the Asthma IQ program

suggest asthma patients seeking care from specialists vs. PCPs are older,

and have more co-morbidities and more severe disease.

124 Characteristics of Asthma Visits to Specialists Compared toPrimary Care Physicians

Michael Schatz, MD, MS, FAAAAI1, Thomas B. Casale, MD,

FAAAAI2, Wilson Pace3, Ryan Walters4, Paul Turner4, Kurtis S. Elward,

MD5; 1Kaiser Permanente, San Diego, CA, 2Creighton University School

of Medicine, Omaha, NE, 3U Colorado, Denver, 4Creighton University,5American Academy of Family Physicians, Charlottesville, VA.

RATIONALE: It is believed that patients who seek care from specialists

have different characteristics and may receive different care compared to

patients treated by primary care physicians (PCPs), but there are few

published data on this subject.

METHODS: Asthma IQ is an on-line program that provides a guideline-

based framework for asthma assessment andmanagement. Selected patient

and visit characteristics were compared in 2,614 unique patient entries

from specialists to 270 unique patient entries from PCPs into the Asthma

IQ program. Statistical significance was set at p < 0.05.

RESULTS: Significantly more PCP visits (38.1 %) than specialists’ visits

(16.6 %) were acute visits for exacerbations. Compared to PCPs’ patients,

asthma in specialists patients was significantly more likely to be triggered

by animals (32.6 % vs. 8.5 %), dust (27.8 % vs. 11.9 %), and aspirin (1.5 %

vs. 0.0 %). Asthma action plans were possessed by significantly more

specialists’ patients (36.4 %) than PC patients (18.5 %). Specialists’

patients were significantly more likely to be receiving long-term control-

lers than PCPs’ patients (72.0 % vs. 61.1 %), including inhaled cortico-

steroids (66.2% vs. 50.4 %), long-acting beta agonists (34.1% vs. 14.1 %),

leukotriene receptor antagonists (27.0% vs. 18.9 %), and omalizumab (2.8

% vs. 0.0 %).

CONCLUSIONS: Patients of specialists report more allergic triggers,

which may reflect patient self-selection or referral patterns. It is not clear

whether less prophylactic care is the result or the cause of more acute PCP

asthma visits, but both increased non-acute visits and more preventative

care are probably desirable.

125 Tweeting the Meeting: Investigating Twitter Activity At the2012 AAAAI Conference

NehaMehrotra, MD1, Vesselin Dimov, MD2; 1University of Chicago, IL,2MC 0729, C-150B, Department of Pediatrics, University of Chicago,

Chicago, IL.

RATIONALE: The American Academy of Allergy, Asthma and

Immunology (AAAAI) increased its efforts to use social media to

disseminate medical information from its annual meetings. Twitter, a

popularmicroblogging service, is onemethod used to accomplish this goal.

This study investigated the use of Twitter during the 2012AAAAImeeting.

The working hypothesis was that a large number of educational tweets

were disseminated to the public.

METHODS: ATwitter search was performed using the hashtag #AAAAI.

Tweets were divided into 8 categories: fact, link, retweet, reply, query,

status, advertisement, and opinion. TweetReach.com estimated the number

of individuals who read the tweets, an objective measure of the number of

people the information was disseminated to.

RESULTS: The 2012 AAAAI meeting had 5,041 registered delegates and

25 allergists (0.49% of the attendees) used Twitter to publish 2,650 tweets.

Their tweets reached 250,000 people, nearly 50 times the number of people

who attended the meeting. Of the tweets, 1,397 (52.7%) were facts and

7.2% (192) were facts with links to support the factual information. There

were 366 (13.8%) replies, 274 (10.3%) status updates, 219 (8.2%) retweets,

112 (4.2%) opinions, 46 (1.7%) queries and 25 (0.9%) advertisements.

CONCLUSIONS: Social media, and Twitter in particular, is an efficient

way to disseminate medical information to medical professionals and the

public. A small subset of 25 allergists expanded the educational reach of the

2012 AAAAI annual meeting to 250,000 individuals. A more organized

approach and improvedparticipation amongattendees could further increase

awareness of the specialty in cost-effective and time-efficient manner.

126 Change in Food Allergy Knowledge Among Urban PublicSchool Nurses After a Standardized Educational Curriculum

Sarah Twichell, MD, MPH1, Humaira Robinson, RN, BSN1, Eleanor

Garrow, BHA2, Maria L. Acebal, JD2, Hemant P. Sharma, MD, MHS,

FAAAAI1; 1Children’s National Medical Center, Division of Allergy

and Immunology, Washington, DC, 2Food Allergy & Anaphylaxis Net-

work, Fairfax, VA.

RATIONALE: Children with food allergy are at increased risk of having

an allergic reaction at school. While needs assessments regarding school

nurse food allergy knowledge exist, evaluations of specific educational

programs are lacking.

METHODS: A 20-item food allergy knowledge questionnaire was

administered to 173 District of Columbia public school nurses before

and after attending a standardized food allergy education program.

Changes in paired knowledge scores (calculated as percentage of correct

responses, range 0 to 100) were assessed. Three and 6-month follow-up

assessments were administered to a subsample of participants.

RESULTS: Summary mean knowledge scores increased from 77 to 93

(p<0.001) between the pre- and post-test. There was a significant increasein paired knowledge scores across all content domains: basic food allergy

knowledge (mean increase515), food allergen avoidance (increase514),

symptom recognition (increase512), and treatment (increase520)

(p<0.0001 for all comparisons). The greatest knowledge improvements

related to recognition that epinephrine is not a dangerous drugwith harmful

side effects (prevalence of correct response increased by 58%), use of

antibacterial hand sanitizer after eating is not effective (52%), and a second

dose of epinephrine could safely be administered if symptoms persist

(36%). At 3 and 6months, summary knowledge scores were both 88, which

remained significantly higher than the pre-test score and non-significantly

lower than the post-test score.

CONCLUSIONS: In this sample of urban school nurses, food allergy

education significantly improved knowledge, especially related to treat-

ment of reactions. Additional studies are needed to determine whether

these knowledge gains persist beyond six months and lead to improved

outcomes.