Nearly 50% of children in the US are Medicaid-insured, with some having poor health literacy and little access to medications and specialty care, which affects treatment utilization for pediatric patients with atopic dermatitis (AD), the commonest inflammatory skin disease in children. A recent study assessed and compared treatment patterns and healthcare resource utilization (HCRU) between large cohorts of Medicaid and commercially insured children with AD.

It identified the pediatric patients with AD from 2 large US healthcare claims databases (2011-2016) and included patients having continuous health plan eligibility for ≥6 months before and ≥12 months after the first AD diagnosis (index date). It excluded patients with an autoimmune disease diagnosis within 6 months of the index date. The study compared the treatment patterns and all-cause and AD-related HCRU during the observation period between commercially and Medicaid-insured children.

The observations were as follows:

• Only a few children were evaluated by a dermatology or allergy/immunology specialist.
• Commercially and Medicaid-insured children with AD showed many significant differences.
• Differences seen for Medicaid-insured children were: comparatively less access to specialist care, higher utilization of emergency department and urgent care center, more prevalence of asthma and non-atopic morbidities, in-frequent prescription of high-potency topical corticosteroids and calcineurin inhibitors, and >3-fold prescriptions for antihistamines, despite similar rates of comorbid asthma and allergies among antihistamine users.
• A significant difference was observed in treatment patterns across physician specialties.

These results indicate obstacles in accessing specialty care for all children with AD and substantial differences in management between commercially and Medicaid-insured children. These disparities in treatment and access to specialty care may lead to poor AD control, especially in Medicaid-insured patients.

Source: Siegfried EC, Paller AS, Mina-Osorio P, et al. Effects of variations in access to care for children with atopic dermatitis. BMC Dermatol. 2020;20:24.