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Factors associated with non-attendance at pediatric subspecialty asthma clinics
Esther Y Yoon1, Matthew M Davis, Jeanne Van Cleave
1Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan 48109-0456, USA. est@med.umich.edu
Insights
Children with Medicaid insurance are less likely to attend subspecialty asthma care appointments. This non-attendance is higher during fall months, impacting pediatric asthma care access.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Health Equity
Background:
- Children with Medicaid insurance experience disparities in accessing subspecialty asthma care.
- Patient non-attendance at scheduled visits may contribute to these observed disparities.
Purpose of the Study:
- To identify factors associated with missed appointments for pediatric subspecialty asthma care.
- To understand barriers to accessing specialized asthma treatment for children.
Main Methods:
- Cross-sectional study of 1236 scheduled visits across three pediatric asthma clinics.
- Logistic regression analysis controlling for patient demographics, insurance, illness severity, and visit scheduling factors.
- Examined non-attendance rates based on insurance type, visit timing, and other covariates.
Main Results:
- The overall non-attendance rate was 8%.
- Medicaid insurance was significantly associated with a higher likelihood of non-attendance (OR 2.33).
- Visits scheduled during September-December showed a substantially higher non-attendance rate (OR 3.26).
Conclusions:
- Children with Medicaid insurance are less likely to attend scheduled subspecialty asthma visits, even after accounting for seasonal factors.
- Interventions to reduce disparities in pediatric asthma care should address patient attendance barriers, particularly during the fall season.
Background:
Children with Medicaid insurance are less likely to receive subspecialty asthma care than non-Medicaid patients. However, it is not clear if such disparities are due to non-attendance at scheduled visits by patients.
Objective:
To determine factors associated with non-attendance at scheduled visits for pediatric subspecialty asthma care.
Design/Methods:
We conducted a cross-sectional study of children with scheduled visits at three asthma clinics during a 12-month period. Our outcome of interest was patient non-attendance for a scheduled visit, controlling for age, gender, new patient status, type of insurance, severity of illness, distance to clinic, clinic site, month, and weekday of scheduled visit. We used logistic regression for multivariate comparisons and controlled for clustering effects for children with multiple scheduled visits.
Results:
There were 1236 scheduled visits for 857 unique patients. Median age: 7 years (IQR 3-11); median distance traveled: 24 miles (IQR 13-41); 20% had Medicaid insurance. The non-attendance rate was 8%. In multivariate analysis, Medicaid insurance (OR 2.33, 95% CI 1.45-3.74) and visits scheduled in September-December (3.26, 2.08-5.11) were associated with non-attendance.
Conclusions:
Children with Medicaid insurance are less likely to attend scheduled visits for subspecialty asthma care, controlling for seasonal variation. Programs designed to address disparities in pediatric asthma outcomes regarding subspecialist care may improve their effectiveness by addressing barriers to attendance and anticipating poor attendance in the fall season.
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