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Access to specialty pediatric asthma care is influenced by the number of clinicians available, insurance, and travel time.

While children with asthma experience improved outcomes when seeing asthma specialists, this level of care may not be available if there are no specialists in the area or if nearby specialists do not treat children or accept the child’s insurance.

 For research published in the Journal of Asthma and Allergy, researchers described the physical proximity of children to pediatric asthma specialty care in Maine and evaluated how the availability of such care was influenced by providers’ non-acceptance of pediatric patients and those with Medicaid insurance.

“Maine is the second most rural of the United States and home to more than 22,000 children (8.5% of the child population) with current asthma,” James C. Bohnhoff, MD, and colleagues wrote.

 The cross-sectional telephone survey of pediatric pulmonology and allergy/immunology practices in and around Maine was conducted in June and July of 2024, asking whether each specialist accepted pediatric patients, whether they accepted Maine Medicaid insurance, and what their wait times were for new patient appointments. The investigators also assessed whether patient acceptance policies differed by specialty, training, and location.

Access to Specialist Asthma Care for Children

Of the 49 pediatric asthma specialists in Maine and adjacent areas, 84% accepted pediatric patients. Pediatric pulmonologists and in-state providers were significantly more likely to accept children with Maine Medicaid insurance (100% and 88.9%; P=0.004) compared with allergists and out-of-state providers (32% and 6%, respectively; P<0.001). Both asthma specialists in Maine and neighboring areas had reasonable appointment wait times (3 months and 1 month, respectively).

The median travel time to any asthma specialist in Maine was 30.5 minutes (interquartile range [IQR], 17.2-51.0), with 18% of children traveling more than 60 minutes, which may pose considerable direct and indirect financial burdens for some families, according to the study authors. When considering specific specialties, the median travel time to an allergists-immunologist was 33.5 minutes (IQR, 19.0-51.7).

Limiting the analysis to allergists who treat children did not affect children’s median travel times. However, when further restricted to allergist-immunologists who accept Maine Medicaid, the median travel time to the closest provider increased to 40.2 minutes (IQR, 24.6-63.0), with 27.2% of children needing to travel over an hour for care. The median travel time from children in Maine to a pulmonologist was 45.2 minutes (IQR, 29.3-67.0).

“Future research is needed to assess the degree to which these limitations impact receipt of care and clinical outcomes among children with asthma,” the authors wrote.