Deception in Allergy Care: Minorities and Underserved Denied Safe, Effective Allergy Care

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AAAPC is fighting anticompetitive efforts that keep patients from receiving allergy and asthma care from their primary care doctors.

Each year, the Asthma and Allergy Foundation of America (AAFA) declares May "National Asthma and Allergy Awareness Month." For the 50 million Americans who suffer from allergies and asthma, it is hard to ignore the epidemic that is plaguing our nation. Not only do these conditions negatively impact sufferers’ quality of life, they also account for lost time from work or school, added cost to patients and, ultimately, a significant financial burden on the health system. It is also hard to ignore that groups of allergists are attempting to limit care and access to care for underserved children, including minority children.

More than 50 million Americans suffer from allergies, but there are currently less than 2,800 practicing allergists in the United States. Yet there are 250,000 primary care physicians that could be leveraged to create access to care that so many desperately need.

Asthma is the most common chronic disease in childhood, impacting an estimated 6.5 million Americans under the age of 18. It is the primary reason children miss school and the leading cause of childhood hospitalization. Furthermore, the CDC recently reported that not only has the prevalence of asthma increased from 7.3 percent in 2001 to 8.4 percent in 2010, but minority and lower income populations are being hit hardest. African Americans and Hispanics manifest the highest asthma prevalence (11.2 percent and 16.1 percent respectively) in contrast to that of Caucasians (7.7 percent) and Asian Americans (5.2 percent). Today, 11.2 percent of individuals living below the poverty line have asthma. Not surprisingly, asthma is associated with high rates of healthcare utilization. Recently, in one year alone, asthma was responsible for 1.3 million visits to hospital outpatient departments and 1.8 million emergency department visits, with the average length of stay for inpatient care for asthma patients being 3.6 days. Sadly, the condition is associated with thousands of deaths each year.

With high healthcare utilization, associated comorbidities and medication expenditures, the annual cost of asthma –estimated to be nearly $56 billion, according to the CDC—is staggering.

The burden of asthma today, both in terms of cost as well as impact on vulnerable patient populations, is heavy and continuing to grow. Increasing access to high quality care for allergic asthma, as well as allergic rhinitis, is critical. This tragic health disparity and the progression of allergies to asthma can be prevented through allergen-specific subcutaneous immunotherapy (SCIT), or more simply allergy shots. Immunotherapy has been shown in clinical trials to reduce allergy symptoms and prevent the onset of new allergies and asthma.

Accessibility to allergy services must be increased by providing primary care support services and shifting healthcare delivery away from fragmented specialty silos. Keenly aware of the misallocation of allergy treatment resources, SCIT delivery support would be of maximum benefit in primary care.

The answer to creating access lies in the hands of the exponentially more primary care physicians who can treat a majority of these patients in an effective manner. Primary care practices safely use immunotherapy through a new patient-centered care model. Most primary care practices minimize the potential occurrence of adverse reactions by carefully selecting their patients and by utilizing a build-up phase that also emphasizes patient education and compliance. This model is appropriate for those with mild to moderate seasonal and perennial allergies. A Tufts University Department of Otolaryngology and Uppsala University Department of Immunology study examined 635,600 patients who received more than 1.1 million injections. Sixty percent of the shots were administered at home. The study found that home administration resulted in significantly fewer (26-fold) major reactions than office-based immunotherapy.

Out of concern that anticompetitive activities in the healthcare marketplace needlessly result in healthcare disparities for allergy and asthma care, particularly for minority children, the Academy of Allergy and Asthma in Primary Care (AAAPC) filed comments on April 30, 2014 with the Federal Trade Commission. The AAAPC’s mission is to foster the ability of physicians to provide high quality, patient-accessible diagnostic and therapeutic allergy and asthma care. The AAAPC is the voice for thousands of physicians and patients using allergy and asthma diagnostic and therapeutic services to raise awareness of the link between allergy care and asthma prevention, particularly in pediatric and family practice populations.

Anticompetitive efforts by the allergists include attempting to restrict reimbursement and coverage, intimidating primary care physicians from practicing allergy care within their scope of practice, coercing and persuading allergist colleagues to boycott primary care physicians, and supporting and weighing in on self-generated complaints by allergists to medical boards. Such anticompetitive behavior is keeping patients from receiving this treatment from their trusted source: their primary care doctors.

Based on the safety of the primary care protocol for immunotherapy, the AAAPC is working with the primary care community to expand needed access to testing, diagnosis and treatment for allergy and asthma to underserved populations. During his State of the Union address, President Obama referenced the health reform law and said that “A rural doctor gave a young child the first prescription to treat asthma that his mother could afford.” The AAAPC wants to ensure that doctor, the young patient and others like them have the opportunity to benefit from safe and effective immunotherapy.

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