247 Subspecialist utilization for pediatric asthma

Objectives/Goals: Some children with asthma benefit from care from asthma specialists: allergist/immunologists or pulmonologists. However, a limited supply of specialists poses access problems for some children. Our objective was to describe the state of specialist care for pediatric asthma in Maine. Methods/Study Population: Using Maine all-payer claims data for April 2018–April 2021, we identified children with asthma meeting criteria for subspecialist referral based on NIH Expert Panel Report criteria. We determined which of these children had encounters with an allergist-immunologist or pediatric pulmonologist during the study period and performed logistic regressions to determine what demographic traits were associated with receipt of care. Results/Anticipated Results: Among children meeting criteria for specialists referral, 33% had an encounter with an asthma specialist. Specialist encounters were associated with younger age (p<0.001) and male sex (p = 0.003). Encounters were negatively associated with Medicaid insurance (versus commercial, p<0.001) and living in more rural areas (RUCA codes 4–10, p<0.001), lower childhood opportunity index (high or less, <0.001), and longer travel time to pediatric asthma specialists in Maine (<0.001). Discussion/Significance of Impact: Specialist care for children with complex or severe asthma is an evidence-based practice that is not equally accessible to all children in Maine. This may restrict their access to specific asthma therapies such as allergic desensitization and monoclonal antibodies.