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

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...

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Autores principales: Siegfried, Elaine C., Paller, Amy S., Mina-Osorio, Paola, Vekeman, Francis, Kaur, Mandeep, Mallya, Usha G., Héroux, Julie, Miao, Raymond, Gadkari, Abhijit
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749983/
https://www.ncbi.nlm.nih.gov/pubmed/33341118
http://dx.doi.org/10.1186/s12895-020-00114-x
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author Siegfried, Elaine C.
Paller, Amy S.
Mina-Osorio, Paola
Vekeman, Francis
Kaur, Mandeep
Mallya, Usha G.
Héroux, Julie
Miao, Raymond
Gadkari, Abhijit
author_facet Siegfried, Elaine C.
Paller, Amy S.
Mina-Osorio, Paola
Vekeman, Francis
Kaur, Mandeep
Mallya, Usha G.
Héroux, Julie
Miao, Raymond
Gadkari, Abhijit
author_sort Siegfried, Elaine C.
collection PubMed
description 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. SUPPLEMENTARY INFORMATION: Supplementary information accompanies this paper at 10.1186/s12895-020-00114-x.
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spelling pubmed-77499832020-12-22 Effects of variations in access to care for children with atopic dermatitis Siegfried, Elaine C. Paller, Amy S. Mina-Osorio, Paola Vekeman, Francis Kaur, Mandeep Mallya, Usha G. Héroux, Julie Miao, Raymond Gadkari, Abhijit BMC Dermatol Research Article 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. SUPPLEMENTARY INFORMATION: Supplementary information accompanies this paper at 10.1186/s12895-020-00114-x. BioMed Central 2020-12-20 /pmc/articles/PMC7749983/ /pubmed/33341118 http://dx.doi.org/10.1186/s12895-020-00114-x Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Siegfried, Elaine C.
Paller, Amy S.
Mina-Osorio, Paola
Vekeman, Francis
Kaur, Mandeep
Mallya, Usha G.
Héroux, Julie
Miao, Raymond
Gadkari, Abhijit
Effects of variations in access to care for children with atopic dermatitis
title Effects of variations in access to care for children with atopic dermatitis
title_full Effects of variations in access to care for children with atopic dermatitis
title_fullStr Effects of variations in access to care for children with atopic dermatitis
title_full_unstemmed Effects of variations in access to care for children with atopic dermatitis
title_short Effects of variations in access to care for children with atopic dermatitis
title_sort effects of variations in access to care for children with atopic dermatitis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749983/
https://www.ncbi.nlm.nih.gov/pubmed/33341118
http://dx.doi.org/10.1186/s12895-020-00114-x
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