Characteristics of asthmatics using an urban accident and emergency department

The demographic characteristics of patients attending the Middlemore Hospital accident and emergency department with asthma were studied prospectively over a 3 month period. Pacific Islanders and Maoris used A & E more and were more frequently admitted because of asthma than Europeans (p less than 0.0001). Independent of race, patients living in close proximity were more likely to attend A & E and to be admitted than patients living distant from hospital (p less than 0.0001). When compared with asthmatics referred by a general practitioner, self-referred asthmatics attended more frequently out of hours (p less than 0.05) and were disproportionately of lower socioeconomic classes (p less than 0.01). Eighty two percent of asthmatics perceived A&E as the most appropriate place to have their acute attacks managed. The demographic characteristics of those using A & E suggests that there are attitudinal, organisational and financial barriers to primary health care in the community which may have contributed to a shift from community to hospital based management of acute asthma, and this may explain some of the increase in hospital admissions for asthma.