Effects of variations in access to care for children with atopic dermatitis

Abstract

Background: An estimated 50% of children in the US are Medicaid-insured. Some of these patients have poor health literacy and limited access to medications and specialty care. These factors affect treatment utilization for pediatric patients with atopic dermatitis (AD), the most common inflammatory skin disease in children. This study assesses and compares treatment patterns and healthcare resource utilization (HCRU) between large cohorts of Medicaid and commercially insured children with AD.

Methods: Pediatric patients with AD were identified from 2 large US healthcare claims databases (2011-2016). Included patients had continuous health plan eligibility for ≥6 months before and ≥12 months after the first AD diagnosis (index date). Patients with an autoimmune disease diagnosis within 6 months of the index date were excluded. Treatment patterns and all-cause and AD-related HCRU during the observation period were compared between commercially and Medicaid-insured children.

Results: A minority of children were evaluated by a dermatology or allergy/immunology specialist. Several significant differences were observed between commercially and Medicaid-insured children with AD. Disparities detected for Medicaid-insured children included: comparatively fewer received specialist care, emergency department and urgent care center utilization was higher, a greater proportion had asthma and non-atopic morbidities, high- potency topical corticosteroids and calcineurin inhibitors were less often prescribed, and prescriptions for antihistamines were more than three times higher, despite similar rates of comorbid asthma and allergies among antihistamine users. Treatment patterns also varied substantially across physician specialties.

Conclusions: Results suggest barriers in accessing specialty care for all children with AD and significant differences in management between commercially and Medicaid-insured children. These disparities in treatment and access to specialty care may contribute to poor AD control, especially in Medicaid-insured patients.

Keywords: Access to care; Atopic dermatitis; Atopic eczema; Children; Emergency department reliance; Medicaid; Private insurance.

Fig. 1

Incidence Rate Ratios of All-Cause HCRU of Patients with AD – Medicaid vs. Commercial (Reference Group). Notes: AD: atopic dermatitis; ED: emergency department; EDR: emergency department reliance; HCRU: healthcare resource utilization. 1. Estimated using generalized linear models with a log link and negative binomial distribution, adjusting for baseline demographics and clinical characteristics. 2. High EDR is defined with a percentage of ambulatory visits occurring in the ED of at least 33% (i.e., EDR >0.33). 3. Includes primarily patient home, independent laboratory, and other unlisted facilities. *P-value <0.05