Geographic access to specialist care matters

Published Online: March 19, 2015

Asthma is a chronic childhood condition that impairs quality of life, and contributes significant costs to the health care system, particularly in terms of emergency department (ED) visits and hospitalizations. In many cases, the system could be more cost-effective. Even though asthma is a common disease among children, geographic access to care for asthma exhibits great disparities. In a study recently published in The Journal of Allergy and Clinical Immunology (JACI), Garcia and colleagues analyze the association between the distance children have to travel to receive asthma care and the rate at which children experience severe outcomes. Improvement in medical access was found to potentially reduce severe outcomes.

The authors of this study used mathematical modeling to compute the distance that children in the US states of Georgia and North Carolina are expected to travel to receive asthma specialist care. Statistical modeling was used to quantify the relationship between severe outcomes and determinants to health outcomes, including the travel distance to care, income, education, and age. In North Carolina, the maximum distance to receive asthma specialist care is 30 miles; in contrast, the specialist distances in Georgia are as far as 50 miles, with 23 counties having a travel distance greater than 30 miles. For ED visits and hospitalizations in both Georgia and North Carolina, geographic access measured by travel distance to asthma specialist care is a significant factor in predicting severe outcomes.

The exact relationships between the predictors and severe outcomes are complex, and differ both by outcome and by state. It is therefore not surprising that the same intervention of improving geographic access to specialist care does not produce the same expected decrease in ED visits in both states (the improvement in Georgia is greater) or even for all counties in one state. In order to have the greatest benefit, any intervention must be customized to target the areas with the potential to deliver the highest impact on a specific outcome.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

Close-up of pine tree branches in Winter Close-up of pine tree branches in Winter