Williams to prioritize education as AAAAI president

Key takeaways:

• Many people are unaware of what allergists do.
• Williams wants to collaborate with payers and government to improve protocols.
• Training may benefit from the input of community allergists.

WASHINGTON — Education will be a priority as Paul V. Williams, MD, takes the helm as American Academy of Allergy, Asthma & Immunology president — educating patients, payers and politicians as well as students, researchers and practitioners.

These efforts are necessary, Williams told Healio, because so many people both inside and outside of medicine simply are not familiar with the specialty, which can impact the quality of care.

Educating patients, physicians

“There are lots of examples of patients who aren’t aware of what allergists can do,” Williams, who also is a clinical professor of pediatrics in the division of allergy at University of Washington School of Medicine, told Healio.

Williams believes the AAAAI can play a role in teaching patients about what its members can provide.

“I have had patients with nasal allergies who went to see another specialist for their sinuses and didn’t understand that, as allergists, we take care of all sorts of upper airway disease, sinuses included,” he said. “Short of surgery, we can manage sinus disease as well as if not better than other specialties.”

Similarly, Williams noted patients with food allergy or allergic rhinitis who then see pulmonologists for asthma without knowing that allergists can treat asthma too.

“It’s just not necessary for patients with other allergic diseases to spread themselves out among different specialties when we can manage all of them,” he said.

Physicians in general practice or other specialties would benefit from education about what allergy and asthma specialists can do as well, Williams said.

“Some primary care physicians will run blood tests for allergies on patients with chronic nasal symptoms, and if those blood tests come back negative, they don’t refer them,” he said. “But we take care of both allergic and nonallergic upper airway disease.”

These lapses may be due to how these physicians were trained, Williams said.

“Internal medicine, pediatrics and family practice trainees often don’t have exposure to allergists,” he said. “When they come out of their program and start practice, they tend to refer their patients to other specialists. We think we can do a better job with the diseases that we manage.”

Outreach to medical schools, residencies and fellowship programs will improve awareness, Williams said.

“We’re going to try and find ways to educate these people about what allergists do,” he said.

Many institutions do not have an allergy presence, Williams said, so their primary care students might not have any interaction with allergists.

“We’re going to try to educate department directors, like internal medicine and pediatrics, on the importance of allergists and how it would benefit them to have that specialty involved in their system,” Williams said.

Educating payers, government

As president, Williams said he wants to develop relationships with payers, including education, with an emphasis on communication plans.

“We want to have more of a proactive relationship in protocols for testing or treatment,” he said. “They’re the ones who make the decisions about what they’ll pay for and who would qualify. A lot of times, that’s based on limited knowledge or older knowledge of FDA approvals. They don’t understand new applications for these drugs.”

For example, Williams noted that some protocols ask allergists to demonstrate pulmonary function abnormalities and changes via bronchodilators before treatment can be approved.

“They don’t understand that many asthma patients who have a phenotype of recurrent exacerbations with periods that are symptom-free in between may not be able to fulfill criteria to qualify,” he said.

“And yet, clearly, these patients have been shown to get benefits from biologics in reducing those exacerbations, which is where all the cost comes from with ER visits,” he continued.

Instead of asking payers to revise their protocols once they have been established, Williams said, the AAAAI could work with them to develop new protocols as new therapies become available.

“We know who would benefit and who would qualify,” Williams said. “That would make everybody’s life better. It would probably save the insurance companies some money, and it certainly would take some of the handcuffs off what allergists are trying to do and improve patient care.”

Community allergists would have a part in these communication efforts too.

“There was a plan in the past that has been kind of dormant,” Williams said. “We’re going to refocus on that and try and develop talking points and instructions for community allergists to use with public payers.”

Williams intends to have the AAAAI and these community allergists alike use these talking points to reach out to state, local and federal government to educate policymakers about allergy care as well.

“A lot of people in Congress don’t understand what allergists can do,” Williams said. “When they’re writing rules and regulations about coverage, we want to be remembered and included.”

The government regulates some insurers, Williams continued, so it needs to understand what allergists do when there are issues involving reimbursement and payments.

Additionally, the government needs a better understanding of allergy and asthma care to provide appropriate research funding, which is continuing to fall, Williams said.

“It’s getting harder and harder to get NIH support for our fellows or junior faculty,” Williams said.

Most research funding comes from the National Institute of Allergy and Infectious Diseases and the National Heart, Lung, and Blood Institute, he said.

“We pretty much target both of those institutes in our advocacy,” Williams said.

Citing the importance of studies in food allergy, Williams said that AAAAI has asked the government to increase funding for the Consortium for Food Allergy Research.

“The research that has been done at those centers has led to oral immunotherapy for peanut allergy,” Williams said. “With additional funding, we think we can develop even more treatments instead ofavoidance approaches.”

Allergic rhinitis and rhinitis in general also tend to be underfunded, Williams continued.

“Nobody really cares a lot about it except for allergists,” he said. “So, we’re trying to get more research done in that area.”

Asthma remains an issue and a focus of AAAAI’s advocacy efforts too.

“NIH has some great ongoing research groups that are focused on asthma. We want to make sure that funding continues so we can continue to provide the best patient care for those with asthma,” Williams said.

Educating members

The AAAAI has approximately 7,000 members with seven interest sections and 30 committees. But many of these professionals are “working in silos” without any idea about what other members are doing, Williams said.

“There may be duplication of effort, or the ability to collaborate and improve these efforts,” he said. “We’re trying to figure out a way for members to easily identify if a project they are working on relates to a project that somebody else is working on.”

Many members really don’t know what the AAAAI entirely does, Williams continued.

“They get emails. They have access to the website. But they’re not aware of the all the different things that are available to them,” he said.

Williams said that education about what the AAAAI does should begin early.

“We want to really educate the fellows and get them involved,” he said.

Also, Williams said as president he will prioritize communication and collaboration between community allergists, researchers and institutions that provide training.

“Community allergists benefit from research,” he said. “Training programs can also benefit from community allergists, because the majority of people in the training programs are going to be community allergists.”

There are so many things that students do not really learn when they are in university settings, Williams said, even though they will need to know them when they go into practice.

“I’d like to get those two groups working more together,” he said.

Beyond this collaboration, Williams said that he also wants to establish allergists and immunologists as experts on how the environment impacts respiratory and skin disease, which is becoming more important.

Several AAAAI committees are working on this sustainable project, Williams said, with the goal of focusing their efforts on one direction.

“We want to make sure that our members are well educated about the impacts of the environment and climate change on allergic disease,” he said. “There really is no specialty that fits better into that.”

For more information:

Paul V. Williams, MD, can be reached at pvwilliams@earthlink.net.