Primary Health Care Access, Continuity, and Cost Among Pediatric Patients With Obesity Hypertension

The purpose of this study was to determine how comorbid medical conditions, and the need for early pharmacological intervention, race, gender, and age are associated with service utilization and primary health care costs. From a statewide Medicaid database, medical and pharmacy claims for 10 calendar years (January 1995 to December 2004) were extracted to identify a cohort of children, ages 0 to 17, with (n = 552) and without (n = 2943) a diagnosis of both obesity and primary hypertension. Pediatric African American patients had more diagnosed medical conditions, significantly fewer visits during their first year of primary health care (χ2, 161.16; p < .0001) and significantly lower total service utilization over time (χ2, 10.35; p < .0001); and received significantly fewer face-to-face visits from office-based practitioners (χ2, 19.38; p < .0001) and other medical diagnostic and laboratory services. They also received significantly less acute care through emergency departments (χ2, 25.88; p < .0001) and inpatient facilities (χ2, 23.92; p < .0001), but were in the treatment system for longer periods of time despite their higher prevalence of multiple comorbid conditions. The total cost of care for pediatric African American patients was significantly lower (F, 90.84; p < .0001) than for non-African Americans. In this primary care system, there were early and persistent disparities in the receipt of outpatient, emergency, and inpatient services over time delivered to African American children and adolescents with multiple medical needs.