Access to Pediatric Asthma Specialty Care: A Survey and Geospatial Analysis Across a Rural State.

IF 3.7 3区 医学 Q2 ALLERGY
Journal of Asthma and Allergy Pub Date : 2025-03-21 eCollection Date: 2025-01-01 DOI:10.2147/JAA.S511581
James C Bohnhoff, Dana Schwartz, Anya Cutler, Jill S Halterman
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Abstract

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.

获得儿科哮喘专科护理:一项横跨农村州的调查和地理空间分析。
目的:虽然哮喘患儿就诊于哮喘专科医生(过敏症/免疫学家和儿科肺科医生)可改善预后,但如果附近没有专科医生,或者附近的专科医生不接受儿童或给定的儿童保险,则可能无法获得这种护理。我们的目的是描述在一个主要是农村的州,儿童与儿科哮喘专科护理的物理距离,并评估儿科哮喘专科护理的可获得性在多大程度上受到提供者不接受儿科患者和医疗补助保险患者的影响。方法:我们于2024年6月至7月对缅因州农村及邻近地区的儿科肺病学和过敏/免疫学实践进行了电话调查,询问他们是否接受儿科患者,是否接受缅因州医疗补助保险的儿科患者,以及他们等待新患者预约的时间。我们使用Fisher精确测试评估了接受政策与临床医生专业(过敏vs肺病学)、培训(医生vs高级实践提供者)和州(缅因州vs其他)之间的关联,并计算了缅因州儿童到最近的提供者地点的旅行时间。结果:在缅因州及其周边地区的49名哮喘专家中,41名(84%)接受了儿科患者。89%的缅因州医疗机构和6%的州外医疗机构接受有缅因州医疗补助保险的儿童。到任何哮喘专家的中位数距离为30.5分钟(IQR为17.2,51.0),18%的儿童需要步行60分钟才能得到护理。结论:缅因州近五分之一的儿童需要花60分钟以上的时间才能找到哮喘专家,近五分之一的过敏提供者不接受儿童,很少有州外提供者接受缅因州医疗补助保险。未来的研究应该评估这些障碍对儿童接受照顾的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Asthma and Allergy
Journal of Asthma and Allergy Medicine-Immunology and Allergy
CiteScore
5.30
自引率
6.20%
发文量
185
审稿时长
16 weeks
期刊介绍: An international, peer-reviewed journal publishing original research, reports, editorials and commentaries on the following topics: Asthma; Pulmonary physiology; Asthma related clinical health; Clinical immunology and the immunological basis of disease; Pharmacological interventions and new therapies. Although the main focus of the journal will be to publish research and clinical results in humans, preclinical, animal and in vitro studies will be published where they shed light on disease processes and potential new therapies.
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