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Ambul Pediatr. 2002 Nov-Dec;2(6):456-61.

Receipt of asthma subspecialty care by children in a managed care organization.

Author information

1
Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan Health Care System, Ann Arbor 48109-0456, USA. mcabana@med.umich.edu

Abstract

BACKGROUND:

Although proper outpatient asthma management sometimes requires care from subspecialists, there is little information on factors affecting receipt of subspecialty care in a managed care setting.

OBJECTIVE:

To determine factors associated with receipt of subspecialty care for children with asthma in a managed care organization.

METHODS:

We conducted an analysis of the claims from 3163 children with asthma enrolled in a university-based managed care organization from January 1998 to October 2000. We used logistic regression analysis to determine factors associated with an outpatient asthma visit with an allergist or pulmonologist.

RESULTS:

Of the 3163 patients, 443 (14%) had at least 1 subspecialist visit for asthma; 354 (80%) were seen by an allergist, 63 (14%) were seen by a pulmonologist, and 26 (6%) were seen by both. In multivariate analysis, patients with more severe asthma (odds ratio [OR], 3.81; 95% confidence interval [CI], 2.99-4.86) and older patients (OR, 1.04; 95% CI, 1.02-1.07) were more likely to receive care from a subspecialist. Compared with Medicaid patients, both non-Medicaid patients with copayment (OR, 2.52; 95% CI, 1.85-4.43) and non-Medicaid patients without any copayment (OR, 3.40; 95% CI, 2.35-4.93) were more likely to receive care from an asthma subspecialist.

CONCLUSIONS:

Children insured by Medicaid are less likely to receive care from subspecialists for asthma. Reasons may be due to health care system-related factors, such as accessibility of subspecialists, to physician referral decisions, and/or to patient factors, such as adherence to recommendations to see a subspecialist. Our findings suggest a need to further investigate health care system barriers, physician referral, and patient acceptance and completion of subspecialty referral.

PMID:
12437392
[Indexed for MEDLINE]

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