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

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.