Factors Associated with Non-Attendance at Pediatric Subspecialty Asthma Clinics

Abstract

Background. Children with Medicaid insurance are less likely to receive subspecialty asthma care than non-Medicaid patients. However, it is not clear if such disparities are due to non-attendance at scheduled visits by patients. Objective. To determine factors associated with non-attendance at scheduled visits for pediatric subspecialty asthma care. Design/Methods. We conducted a cross-sectional study of children with scheduled visits at three asthma clinics during a 12-month period. Our outcome of interest was patient non-attendance for a scheduled visit, controlling for age, gender, new patient status, type of insurance, severity of illness, distance to clinic, clinic site, month, and weekday of scheduled visit. We used logistic regression for multivariate comparisons and controlled for clustering effects for children with multiple scheduled visits. Results. There were 1236 scheduled visits for 857 unique patients. Median age: 7 years (IQR 3–11); median distance traveled: 24 miles (IQR 13–41); 20% had Medicaid insurance. The non-attendance rate was 8%. In multivariate analysis, Medicaid insurance (OR 2.33, 95% CI 1.45–3.74) and visits scheduled in September–December (3.26, 2.08–5.11) were associated with non-attendance. Conclusions. Children with Medicaid insurance are less likely to attend scheduled visits for subspecialty asthma care, controlling for seasonal variation. Programs designed to address disparities in pediatric asthma outcomes regarding subspecialist care may improve their effectiveness by addressing barriers to attendance and anticipating poor attendance in the fall season.

Keywords:

• non-attendance
• asthma
• Medicaid
• seasonal variation
• subspecialty care

Abbreviations
CI:	=	confidence interval
CSHCN:	=	Children's Special Health Care Needs Program
ED:	=	emergency department
GIS:	=	Geographic Information Systems
IQR:	=	interquartile range
OR:	=	odds ratio
PCP:	=	primary care provider
SCHIP:	=	State Children's Health Insurance Program