title: Receipt of asthma subspecialty care by children in a managed care organization.
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.
authors.affiliation: 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
authors.forename: Michael
authors.initials: M
authors.lastname: Cabana
authors.forename: David
authors.initials: D
authors.lastname: Bruckman
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Rushton
authors.forename: Susan L
authors.initials: SL
authors.lastname: Bratton
authors.forename: Lee
authors.initials: L
authors.lastname: Green
mesh_terms: D000293:Adolescent; D000486:Allergy and Immunology; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs; D015999:Multivariate Analysis; D010372:Pediatrics; D015272:Pulmonary Medicine; D012017:Referral and Consultation; D014481:United States