Access to Pediatric Asthma Specialty Care: A Survey and Geospatial Analysis Across a Rural State
James C Bohnhoff1,2, Dana Schwartz3, Anya Cutler2
1Department of Pediatrics, MaineHealth, Portland, ME, USA.
Insights
Access to pediatric asthma specialists is limited for many children in rural areas. Barriers include long travel times, specialists not accepting children, and insurance limitations, impacting care access.
Area of Science:
- Pediatric Allergy and Immunology
- Pulmonology
- Rural Health Disparities
Background:
- Children with asthma benefit from specialized care from allergist/immunologists and pediatric pulmonologists.
- Access to this specialized care can be limited by geographic proximity, provider acceptance of pediatric patients, and insurance coverage.
Purpose of the Study:
- To determine the geographic accessibility of pediatric asthma specialty care in a rural state.
- To evaluate how provider acceptance of pediatric patients and Medicaid insurance affects access to care.
Main Methods:
- A telephone survey of pediatric pulmonology and allergy/immunology practices in and around Maine was conducted.
- Data collected included provider acceptance of pediatric patients, Maine Medicaid insurance, and appointment wait times. Travel time analysis was performed for children across Maine.
Main Results:
- Of 49 asthma specialists, 84% accepted pediatric patients.
- Only 6% of out-of-state providers accepted children with Maine Medicaid insurance, compared to 89% of in-state providers.
- 18% of children faced travel times exceeding 60 minutes to reach an asthma specialist.
Conclusions:
- Significant barriers exist for children in Maine seeking asthma specialty care, including travel distance and provider acceptance policies.
- Nearly one in five children require over an hour of travel, and many providers do not accept pediatric patients or Medicaid.
- Further research is needed to understand how these access barriers affect children's asthma management and outcomes.
Objective:
Although children with asthma have improved outcomes when accessing asthma specialists (allergist/immunologists and pediatric pulmonologists), this care may not be available if no specialists are located nearby, or if nearby specialists do not accept children or a given child's insurance. We aimed to describe the physical proximity of children to pediatric asthma specialty care in a largely rural state and to assess the degree to which the availability of pediatric specialty asthma care was impacted by provider nonacceptance of pediatric patients and patients with Medicaid insurance.
Methods:
We conducted a telephone survey of pediatric pulmonology and allergy/immunology practices in the rural state of Maine and adjacent areas during June and July 2024, asking whether they accepted pediatric patients, whether they accepted pediatric patients with Maine Medicaid insurance, and their wait times for new patient appointments. We assessed the association of acceptance policies and clinician specialty (allergy vs pulmonology), training (physician vs advanced practice provider), and state (Maine vs other) using Fisher's exact tests and we calculated the travel time to the nearest provider locations for children across Maine.
Results:
Among 49 asthma specialists in and around Maine, 41 (84%) accepted pediatric patients. Eighty-nine percent of Maine providers and 6% of out-of-state providers accepted children with Maine Medicaid insurance. The median distance to any asthma specialist was 30.5 minutes (IQR 17.2, 51.0) and 18% of children would need to travel >60 minutes for care.
Conclusion:
Nearly one in five children in Maine would be required to travel more than 60 minutes to reach an asthma specialist, nearly one in five allergy providers do not accept children, and few out of state providers accept Maine Medicaid insurance. Future research should assess the impacts of these barriers on children's receipt of care.
Related Concept Videos
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:30Asthma-IV: Nursing Management
First, in...
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...
01:28Physical Assessment of the Respiratory Tract I: Health History
Subjective Data
Subjective data provides vital information about the patient's health history and symptoms. This data is typically collected through interviews in which patients describe their experiences, symptoms, and concerns.
Health history and...
01:30Primary Healthcare Services
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...