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

Abhijit Gadkari,Amy S. Paller,Usha G. Mallya,Paola Mina-Osorio,Mandeep Kaur,Raymond Miao,Elaine C. Siegfried,Francis Vekeman,Julie Héroux

doi:10.1186/s12895-020-00114-x

Abstract

BackgroundAn 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.MethodsPediatric 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.ResultsA 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.ConclusionsResults 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.

Highlights

An estimated 50% of children in the United States (US) are Medicaid-insured
Atopic dermatitis (AD), a chronic inflammatory skin disease characterized by eczematous lesions and intense pruritus [10,11,12,13], is the most common inflammatory skin disease in children, with an estimated prevalence in the United States of about 11–13% among children less than 18 years of age [14, 15]
Sample A total of 268,580 and 338,678 patients were identified in the Medicaid and Commercial cohorts, respectively

Summary

Introduction

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. Skin disease is very common in children, prompting up to 30% of all primary care pediatric visits [9]. Up to one-third of these patients are estimated to have moderate-to-severe disease [16], along with a higher risk of atopic and non-atopic morbidities compared with children without AD [13, 17,18,19]. AD in children is associated with poorer performance in school, difficulties forming social relationships and participating in sports, and increased rates of anxiety, depression, and even suicidal ideation [20, 22, 24]

Objectives

Methods

Results

Conclusion