By Jason S. Sigmon, M.D.
We have a legacy in modern healthcare whereby advances in medical diagnostics increase the healthcare provider’s ability to more efficiently manage specific disease states. These diagnostic advancements must include accurate, reliable and reproducible results as well as being easily accessible for patients. For these diagnostic advances to impact comprehensive management of specific diseases, therapeutic options must be equally available and reproducible.
It is not unusual for the combination of advances in diagnostics and therapeutics to change how and where patients are treated and frequently leads to centralization of disease management at the primary care level, or at least a shift in the relationship between the specialist and the primary care provider.
We don’t have to look far to see how diagnostic and therapeutic advances change the where and how patients are managed if we examine disease states such as diabetes and hypertension. It is clear that these disease states are managed much differently now versus twenty years ago and it is equally clear that the patient has benefited from these changes.
The title of this article mentions ‘barriers’ and therefore I think it’s appropriate for an explanation as to how diagnostic options for specific diseases, or lack thereof, may have barriers that impact patient management. In the example of IgE mediated or triggered diseases such as allergic rhinitis, atopic dermatitis and asthma we can focus on provocative skin testing as an example.
Traditionally, skin testing has been our best diagnostic option, and for accurate, reproducible and reliable results required specialty administration and reporting. An obvious geographic ‘barrier’ exists with this practice. Specialty care is not equally available in rural versus metropolitan areas. Increasingly, I have found that even within our major metropolitan area many limitations exist for patients to travel locally for skin testing diagnostics, such as time away from work and fuel costs.
With serum IgE diagnostics the geographical barrier to accurate diagnosis is overcome. Regardless of the patient’s geography, healthcare providers can determine their patient’s specific IgE sensitivities guiding appropriate pharmacotherapy utilization and environmental or dietary avoidance.
Now that this geographic and efficiency barrier to IgE diagnosis has been overcome with serum specific testing, primary care healthcare providers and specialists are able to more efficiently manage these diseases. Fortunately, advances in pharmacotherapy have paralleled these diagnostic advances allowing primary care healthcare providers to more comprehensively manage these diseases. These advances include not only pharmacotherapy, but specific immunotherapy as well.
While efficient and safe application of specific immunotherapy desensitization at the primary care level is a process that is currently still evolving, the implications of this advance as well as the sub-lingual delivery of immunotherapy is truly leading to a paradigm shift in how IgE diseases are managed. And as our legacy supports in other disease states, the patient is the one who ultimately benefits.