Lack of Specialist Care, Low CAM Ratio Associated with Pediatric Asthma

Olusegun Owotomo, MD, PhD, MPH

Investigators from Washington DC found that among children and adolescents in that area with asthma, a lack of contact with a specialist and a low controller-to-asthma medication ratio (CAM) were associated with lower hospitalization to emergency department ratio (HE ratio), which was best described as a pattern of frequent emergency department (ED) visits that did not result in hospital admission.

The data was detailed in the session “Emergency Department Visits for Asthma Resulting in Hospitalizations Among DC Children and Adolescents: A Population-based Study” which was presented at the American Academy of Pediatrics (AAP) 2021 Virtual Conference this weekend.

Asthma has been the most common chronic respiratory disease and a leading cause of ED visits among children in the United States. It is a disease best managed through effective longitudinal care provided by healthcare experts.

Olusegun Owotomo, MD, PhD, MPH, Children’s National Hospital, Washington DC, and fellow investigators hypothesized that lack of specialist care, low use of primary care, and a low controller to total asthma medication prescription ratio would be associated with lower hospitalization to ED visit ratios among children and adolescents in the District of Columbia (DC).

Additionally, they believed certain ED utilization could be prevented with more effective longitudinal care in pediatric patients with asthma.

The Methods

Owotomo and colleagues recruited a total of 1298 DC children and adolescents, all of whom were 2-17 years of age who made ≥2 ED visits for asthma over a 24-month period from January 1, 2918, to December 31, 2019.

Participants were predominantly black (85.1%) and male (59.8%) who were over 6 years of age.

Investigators derived each participant’s HE ratio during the study period before dividing participants into 3 groups: low HE ratio, moderate HE ratio, and high HE ratio.

The primary independent variable was specialist contact in the prior 24 months , while the secondary independent variables included primary care contact in prior 24 months ( <2, 2, or >2 visits).

The Findings

Owotomo and colleagues found that most patients had a low HE ratio (70.9%), and 55.8% of participants had no specialist contact.

Adjusted models showed that the odds of having a low HE ratio were significantly higher among those who had no specialist contact when compared both to those with a moderate HE ratio (adjOR = 1.84, 95% CI=1.37 – 2.47, p<0.01) and a high HE ratio (adjOR=2.21, 95% CI=1.27 – 3.85, p<0.001).

Additionally, variables such as low CAM ratio, intermittent asthma, age 6 years and older, and black race were significantly associated with low HE ratio as opposed to high HE ratio.

The association between HE ratio and specialist contact remained significant among those with persistent asthma but not among those with intermittent asthma, according to the subgroup analysis stratified by asthma severity.

The data culled from the study prompted investigators to recommend a greater focus on asthma care in pediatric individuals.

“Involving pulmonologists or allergists in asthma care and efforts to achieve better asthma control may result in less non-emergent asthma-related ED utilization,” the team wrote.