Use of asthma specialist care in high-risk inner-city black children

Innercity Black children are at high risk for asthma morbidity. Asthma specialists may improve asthma outcomes. Understanding specialist use among innercity Black children may provide insight into asthma care in this population. We hypothesized that increased asthma morbidity would be associated with increased use of and parental desire for specialist care. Participants were recruited from Baltimore City health plans. Parents of children (2-6 years of age) with asthma were surveyed about their child's asthma, including use of or desire for asthma specialist care. We compared asthma specialist care status (yes or no) and desire for specialist care to asthma morbidity and criteria for specialist referral based on national asthma guidelines. Of 135 children, 23% had severe asthma, but 9% had seen a specialist and 43% met criteria for asthma specialist referral. Forty percent of parents of children not seen by a specialist expressed a desire to see one. Compared to children of parents who did not desire a specialist, children of parents who desired a specialist were more likely to have severe asthma (38% vs. 10%; p < 0.01), poor asthma control (22% vs. 7%; p = 0.02), and parent report that their child was not receiving good medical care (22% vs. 6%, p < 0.01). Among this population with significant asthma morbidity, asthma specialist care is infrequent, despite parent preference for it. Eliciting parental preference for specialist care may be an efficient method to identify children appropriate for specialist care. Improvements in specialist use may improve asthma care and outcomes in innercity Black children.