Pediatric asthma specialist care utilization among marginalized children with poorly controlled asthma

Area of Science:

• Pediatric Asthma Management
• Health Disparities in Healthcare Access
• Clinical Guideline Implementation

Background:

• Asthma remains a significant public health concern, particularly among historically marginalized populations.
• Guideline-recommended specialist care, including pulmonology and allergy services, is crucial for managing uncontrolled asthma.
• Understanding barriers and facilitators to specialist care access is vital for improving health outcomes in vulnerable children.

Purpose of the Study:

• To examine the utilization of guideline-recommended specialist care among historically marginalized children with uncontrolled asthma.
• To identify factors associated with the use of specialist care in this population.

Main Methods:

• Analysis of baseline data from the Telemedicine Enhanced Asthma Management - Uniting Providers (TEAM-UP) trial.
• Inclusion of 325 children aged 4-12 years from Rochester, NY (2018-2023).
• Bivariate and multivariate analyses correlating specialist care use with demographics, asthma outcomes, primary care physician referrals, and caregiver beliefs.

Main Results:

• Only 16% of children saw a specialist in the prior year, despite uncontrolled asthma.
• Children receiving specialist care were younger, more likely to be Hispanic, live in smoke-free homes, have married caregivers, and higher household incomes.
• Primary care physician referrals increased the likelihood of specialist care, but only 23% of children were referred.

Conclusions:

• There is inadequate utilization of asthma specialist care within marginalized communities.
• Primary care physician referrals are a key factor in improving access to recommended specialist care for vulnerable youth with poorly controlled asthma.