Guideline-informed care among Medicaid-enrolled children with food allergy

• Published in: The American journal of managed care Vol. 26; no. 12; pp. 505 - 512
• Main Authors: Kanaley, Madeleine K, Dyer, Ashley A, Negris, Olivia R, Fierstein, Jamie L, Ciaccio, Christina E, Gupta, Ruchi S, Bilaver, Lucy A
• Format: Journal Article
• Language: English
• Published: United States MultiMedia Healthcare Inc 01-12-2020
• Subjects: Children & youth; Diagnostic tests; Emergency medical care; Food allergies; Health administration; Medicaid; Regression analysis; Socioeconomic factors
• ISSN: 1088-0224; 1936-2692
• DOI: 10.37765/ajmc.2020.88538

To describe food allergy (FA)-related service utilization and identify factors associated with guideline-informed care among Medicaid-enrolled US children with FA.
Retrospective cohort study.
We used the 2012 Medicaid Analytic eXtract files to identify children with an FA diagnosis. FA-related services including outpatient allergist visits, emergency department (ED) visits, epinephrine autoinjector prescription fills, and diagnostic testing were identified. Factors associated with services were assessed using logistic regression. Kaplan-Meier survival curves evaluated the time to guideline-informed care, and proportional hazard models determined associated socioeconomic characteristics.
There were 64,276 Medicaid-enrolled children younger than 20 years who had at least 1 claim with an FA diagnosis in 2012. Minority children and those living in a high-poverty county were less likely to have visited an allergist for FA or received diagnostic testing but more likely to have an FA-related ED visit compared with White children and those not living in a high-poverty county. Survival analyses found that of children seen for FA-related primary care or an ED visit, rates of allergist follow-up visits were 21% and 17%, respectively, and rates of epinephrine autoinjector prescription fills were 39% and 41%. Significant associations with guideline-informed care were found by race/ethnicity, dense population, and high-poverty counties.
Although guideline-informed FA care includes follow-up with an allergist and epinephrine autoinjector prescription, this study finds low probabilities of timely service utilization after medical visits, as well as socioeconomic disparities in care.