Predictors of prior asthma specialist care among pediatric patients seen in the emergency department for asthma

Agnihotri, Neha; Pade, Kathryn; Vangala, Sitaram; Thompson, Lindsey R.; Wang, Vincent J.; Okelo, Sande O.

doi:10.1080/02770903.2018.1493600

Cited by 8 publications

(16 citation statements)

References 39 publications

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“…Among the 150 children, 75% had not met with an asthma specialist, suggesting sub-optimal chronic treatment. 9 When emergency department treatment is insufficient, children with uncontrolled asthma might be hospitalized. In the present cohort, the average number of all-cause hospitalizations and hospitalizations due to asthma exacerbation decreased significantly after specialist intervention.…”

Section: Discussionmentioning

confidence: 99%

“…This is expressed by a decline in hospitalization rates and better level of asthma control. 8,9 Although recommended for children, the effect of asthma specialists' intervention on asthma control in the pediatric population is much less explored. [9][10][11] The current study evaluated the effect of asthma specialists' intervention on asthma control, in a large group of Israeli children.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Childhood Asthma – The Effect of Asthma Specialist Intervention on Asthma Control: A Retrospective Review

Rosman

Gabay

Landau

et al. 2021

JAA

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Childhood Asthma – The Effect of Asthma Specialist Intervention on Asthma Control: A Retrospective Review

Rosman

Gabay

Landau

et al. 2021

JAA

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“…• In a 2019 ED study of children seeking asthma care, inappropriate underuse of asthma specialists was observed in this high-risk, primarily Hispanic population. 81 More specifically, 22% of participants reported asthma specialist care, while 75% did not. Chronic asthma care was worse for those not seeing a specialist, including the underuse of controller medications (24 vs. 64%, p < 0.001) and asthma action plans (20 vs. 62%, p < 0.001).…”

Section: Specialist Care Referralsmentioning

confidence: 99%

“…99 In a more recent study of primarily-Hispanic patients seeking ED asthma care, 24% of the children not followed by a specialist reported use of a daily controller medication compared with 64% of those followed by specialists (p < 0.001). 81 In general, the literature has correlated asthma specialist care with increased controller medication use, specialized testing, and fewer exacerbations (►Table 5); however, very few, if any of these studies confirm that a similar benefit is shared with non-White patients. In fact, it appears that most studies of asthma specialists have focused on comparing asthma specialists to each other and/or with primary care (generalist) physicians, typically in terms of adherence to asthma guideline recommendations for asthma care.…”

Section: Asthma Care In Specialist Settingsmentioning

confidence: 99%

“…45,68 There is evidence in the literature that parents support the use of validated questionnaires in their child's asthma care. 109,110,112 It is unclear how often or consistently any of the validated asthma questionnaires is used in asthma specialist settings, but patient-reported data from ED-based studies revealed rates of 1 and 3% in primary care and asthma specialist settings respectively in one study, 81 and 7% overall (including those seeing an asthma specialist care) in another study. 109 More research is needed to see if asthma survey usage rates are similar more broadly across the United States.…”

Section: • Mitchell Et Al Compared Asthma Morbidity Of Black Andmentioning

confidence: 99%

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Racial Inequities in Asthma Care

Okelo

2022

Semin Respir Crit Care Med

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Racial inequities in asthma care are evolving as a recognized factor in long-standing inequities in asthma outcomes (e.g., hospitalization and mortality). Little research has been conducted regarding the presence or absence of racial inequities among patients seen in asthma specialist settings, this is an important area of future research given that asthma specialist care is recommended for patients experiencing the poor asthma outcomes disproportionately experienced by Black and Hispanic patients. This study provides a systematic review of racial asthma care inequities in asthma epidemiology, clinical assessment, medication prescription, and asthma specialist referral practices.

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Health Insurance Type and Outpatient Specialist Care Among Children With Asthma

Geissler,

Shieh,

Krishnan

et al. 2024

JAMA Netw Open

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ImportanceAlthough children with asthma are often successfully treated by primary care clinicians, outpatient specialist care is recommended for those with poorly controlled disease. Little is known about differences in specialist use for asthma among children with Medicaid vs private insurance.ObjectiveTo examine differences among children with asthma regarding receipt of asthma specialist care by insurance type.Design, Setting, and ParticipantsIn this cross-sectional study using data from the Massachusetts All Payer Claims Database (APCD) between 2014 to 2020, children with asthma were identified and differences in receipt of outpatient specialist care by whether their insurance was public (Medicaid and the Children’s Health Insurance Program) or private were examined. Eligible participants included children with asthma in 2015 to 2020 aged 2 to 17 years. Data analysis was conducted from January 2023 to April 2024.ExposureMedicaid vs private insurance.Main Outcomes and MeasuresThe primary outcome was receipt of specialist care (any outpatient visit with a pulmonology, allergy and immunology, or otolaryngology physician). Multivariable logistic regression models estimated differences in receipt of specialist care by insurance type accounting for child and area characteristics including demographics, health status, persistent asthma, calendar year, and zip code characteristics. Additional analyses examined if the associations of specialist care with insurance type varied by asthma persistence and severity, and whether associations varied over time.ResultsAmong 198 101 unique children, there were 432 455 child-year observations (186 296 female [43.1%] and 246 159 male [56.9%]; 211 269 aged 5 to 11 years [48.9%]; 82 108 [19.0%] with persistent asthma) including 286 408 (66.2%) that were Medicaid insured and 146 047 (33.8%) that were privately insured. Although persistent asthma was more common among child-year observations with Medicaid vs private insurance (57 381 [20.0%] vs 24 727 [16.9%]), children with Medicaid were less likely to receive specialist care. Overall, 64 239 child-year observations (14.9%) received specialist care, with substantially lower rates for children with Medicaid vs private insurance (34 093 child-year observations [11.9%] vs 30 146 child-year observations [20.6%]). Regression-based estimates confirmed these disparities; children with Medicaid had 55% lower odds of receiving specialist care (adjusted odds ratio, 0.45; 95% CI, 0.43 to 0.47) and a regression-adjusted 9.7 percentage point (95% CI, −10.4 percentage points to −9.1 percentage points) lower rate of receipt of specialist care. Compared with children with private insurance, there was an additional 3.2 percentage point (95% CI, 2.0 percentage points to 4.4 percentage points) deficit for children with Medicaid with persistent asthma.Conclusions and RelevanceIn this cross-sectional study, children with Medicaid were less likely to receive specialist care, with the largest gaps among those with persistent asthma. These findings suggest that closing this care gap may be one approach to addressing ongoing disparities in asthma outcomes.

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Predictors of prior asthma specialist care among pediatric patients seen in the emergency department for asthma

Abstract: Asthma specialist care was infrequent among this pediatric ED population, consistent with the sub-optimal chronic asthma care we observed. Prospective trials should further investigate if systematic referral to asthma specialists during/after an ED encounter would improve asthma outcomes.

Cited by 8 publications

References 39 publications

Childhood Asthma – The Effect of Asthma Specialist Intervention on Asthma Control: A Retrospective Review

Childhood Asthma – The Effect of Asthma Specialist Intervention on Asthma Control: A Retrospective Review

Racial Inequities in Asthma Care

Health Insurance Type and Outpatient Specialist Care Among Children With Asthma

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