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

To describe the use of guideline-recommended specialist care (i.e., pulmonology, allergy) among historically marginalized children with uncontrolled asthma and explore factors associated with specialist care use.

We analyzed baseline data from the Telemedicine Enhanced Asthma Management - Uniting Providers (TEAM-UP) trial in Rochester, NY (2018-2023). Caregivers reported on their child's demographics, specialist care utilization/perceptions, and recent asthma symptoms. We conducted bivariate and multivariate analyses to compare specialist care use with demographics, asthma outcomes, primary care physician (PCP) referrals, and caregiver beliefs regarding specialist care.

Among the 325 enrolled children ages 4-12 years (participation rate 62%; 60% male, 35% Hispanic, 58% Black, 80% public insurance), 37% had ever been seen by a specialist and 16% saw a specialist in the prior year. Compared to children who did not see a specialist in the prior year, those who received specialist care were younger, and more were Hispanic, lived in smoke-free homes, had married caregivers, and had household incomes of at or >$35,000. While PCP referrals increased the likelihood of children receiving specialist care, only 23% of children were referred to a specialist by their PCP. Among those not seen by a specialist, 38% reported allergic rhinitis, 42% had smoke exposure within the home, and 81% of caregivers felt specialist care would be helpful for their child.

This study emphasizes inadequate use of asthma specialist care among marginalized communities, and how PCP referrals may improve the receipt of guideline-recommended specialist care for vulnerable youth with poorly controlled asthma.