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Parental decision making associated with pediatric emergency department use for asthma
Shawna S Mudd1, C Jean Ogborn2, Mary Elizabeth Bollinger3
1Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland.
Insights
Caregivers often use the emergency department (ED) for pediatric asthma due to perceived urgency, preference for ED care, or access issues with primary care. Addressing these factors can improve asthma management for disadvantaged children.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Health Disparities
Background:
- Disadvantaged minority children experience disproportionately high rates of asthma.
- These children frequently utilize emergency departments (EDs) for asthma-related care.
- Understanding ED utilization is crucial for cost-effective asthma management.
Purpose of the Study:
- To investigate caregiver factors influencing the decision to use the ED for asthma care in inner-city children.
- To identify key drivers behind emergency care seeking for pediatric asthma.
Main Methods:
- A cluster analysis was performed on data from 150 caregivers of children with asthma who visited the ED.
- Questionnaires and interviews assessed sociodemographics, health characteristics, and caregiver decision-making factors.
- Data were collected during the child's ED asthma visit within a randomized clinical trial.
Main Results:
- Three primary clusters of decision-making emerged: perceived urgency, preference for ED care, and access to care issues.
- Perceived urgency was the most cited reason (91%), followed by preference for the ED (37%) and access issues (31%).
- Inability to secure same-day primary care appointments was a significant access barrier (24%).
Conclusions:
- Caregiver factors influencing ED use for pediatric asthma are multifaceted.
- Interventions should address caregiver asthma home management, primary care relationships, and access to care.
- Findings can inform targeted strategies to reduce unnecessary ED visits and improve asthma outcomes.
Background:
Disadvantaged minority children are disproportionately affected by asthma. This group is also known to frequently use the emergency department (ED) for asthma care. Understanding decisions for use of the ED is important to prevent high cost.
Objective:
To examine caregiver factors associated with the decision to use the ED for asthma care in inner-city children with asthma.
Methods:
One hundred fifty participants in a randomized clinical trial testing the effectiveness of a home-based asthma intervention were enrolled, and questionnaires were administered to caregivers during the child's ED asthma visit. Sociodemographics, health characteristic data, and caregiver interview data were examined to ascertain factors that affected caregiver decision making to use the ED for asthma care. A cluster analysis was performed to correlate caregiver reasons for the decision to use the ED for asthma care.
Results:
Three clusters emerged for decision making: urgency, preference for the use of the ED, and access to care issues. The perception of urgency was the most common reason reported by caregivers (91%) followed by reporting a preference for the ED for care (37%) and reporting access to care issues (31%). Access to care was primarily attributable to the inability to get a same-day appointment with their primary care practitioner (24%).
Conclusion:
The caregiver factors involved in the decision to use the ED can provide a basis for further intervention and investigation. Such factors include caregiver asthma home management, improvement in relationships with primary care practitioners, and access to care-related issues.
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