486 - Access to pediatric asthma specialty care in rural states: A survey and geospatial analysis across Maine

Publication Number: 486.3896

James Bohnhoff, The Barbara Bush Children's Hospital at Maine Medical Center, Portland, ME, United States; Dana M. Schwartz, Hamilton College, Cape Elizabeth, ME, United States; Anya Cutler, MaineHealth Institute for Research, Montpelier, VT, United States; Jill S.. Halterman, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States

Background: Care from asthma specialists (allergist/immunologists and pediatric pulmonologists) can be an important component of pediatric asthma management. However, access to this care may be impacted if specialists are not present in a child’s area or do not accept a child’s insurance.

Objective: We aimed to describe access to pediatric asthma care across a largely rural state and to determine differences in access to asthma specialist care associated with acceptance of pediatric patients and patients with Medicaid insurance.

Design/Methods: We conducted a telephone survey of all pediatric pulmonology and allergy/immunology practices in Maine and adjacent areas to determine whether they accepted pediatric patients, whether they accepted pediatric patients with Maine Medicaid insurance, and their wait times for new patient appointments. We compared acceptance policies based on clinician traits using chi-squared tests and calculated the travel time to the nearest provider locations for children across Maine.

Results: Among 49 asthma specialists in and around Maine, 41 accepted pediatric patients and 18 accepted children with Maine Medicaid insurance. Pediatric pulmonary specialists and in-state providers were more likely to accept children with Maine Medicaid insurance compared to allergists and out of state providers (p=0.002 and p< 0.001). The median wait time until the next available specialist appointment was 2 months. 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(s): Although most asthma specialists in and around Maine accept pediatric patients many do not accept children with Maine Medicaid insurance and a significant percentage of children would be required to travel more than 60 minutes to receive specialist care. Future research is needed to assess the impact of distance to asthma specialty care as well as provider policies around insurance acceptance on receipt of care and clinical outcomes among children with asthma.

Table 1: Acceptance of pediatric patients and Maine Medicaid among asthma specialists in and around Maine
MD, Medical Doctorate; DO, Doctor of Osteopathic Medicine; NP, Nurse Practitioner; ME, Maine.

Table 2: Locations of pediatric asthma specialty care in Maine and adjacent areas, and travel time to locations for all children in Maine (n = 207,409).
IQR, Interquartile range. Because all pulmonologists were in Maine and accepted children with Maine Medicaid insurance, our counts and distances for pulmonologists match those of a previous study on distances to pediatric subspecialist outreach clinics.(12)