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Utilization of the emergency department as a routine source of care among children with asthma
Erin Davis1, Maria Fagnano1, Jill S Halterman1
1University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Insights
Many children with persistent asthma rely on emergency departments (EDs) for regular care. This is linked to proximity needs, poorer quality of life, and past care-seeking patterns, highlighting a need for better outpatient access.
Area of Science:
- Pediatric Emergency Medicine
- Asthma Management
- Healthcare Utilization
Background:
- Persistent asthma affects many children, leading to frequent healthcare needs.
- Emergency departments (EDs) are often utilized for asthma care, but patterns of consistent use are not well understood.
- Understanding why children with asthma frequently use EDs is crucial for improving care delivery.
Purpose of the Study:
- To characterize children with persistent asthma who receive most healthcare in EDs.
- To identify factors associated with using the ED as a primary care location.
- To explore the relationship between recent asthma experiences, care history, and ED utilization.
Main Methods:
- Sub-analysis of baseline data from the Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED) randomized controlled trial.
- Included children aged 3-12 years with persistent asthma presenting to the ED (2016-2020).
- Caregivers reported reasons for ED visits and whether the ED was their primary healthcare source ('ED Care' vs. 'Other Care'), alongside demographic, symptom, quality of life, and healthcare use data.
Main Results:
- Analyzed data from 355 children; 31% were classified as 'ED Care'.
- Children in the 'ED Care' group were more likely to view the ED as the closest healthcare source, reported poorer quality of life, and used the ED for usual sick care, despite having a primary care physician (PCP).
- Fewer symptom nights were reported in the 'ED Care' group, suggesting care may be sought reactively rather than preventatively.
Conclusions:
- A significant proportion of children with persistent asthma utilize the ED as a regular healthcare source.
- Key distinguishing factors include the need for proximity, reduced caregiver quality of life, and established patterns of seeking care in the ED.
- Improving outpatient access and reinforcing PCP-directed asthma management, potentially via telemedicine, could decrease ED visits and associated morbidity.
Abstract:
Objective: To describe characteristics of children with persistent asthma in the ED who receive most of their healthcare in emergency settings; and determine whether recent asthma experiences or historic patterns of care are associated with identifying the ED as a typical location for care.Methods: We conducted a sub-analysis of baseline data from Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED), an RCT of children (3-12 years) presenting to the ED with persistent asthma (2016-2020). Caregivers identified reasons for seeking emergency care, including if their child received most overall healthcare in the ED ('ED Care'; primary outcome) or not ('Other Care'). Independent variables included demographics, recent symptoms and quality of life (QOL), and historic preventive care and healthcare use. We compared responses between ED Care and Other Care groups using bivariate and multivariate analyses.Results: We analyzed data for 355 children (31% ED Care, 69% Other Care). Compared with Other Care, ED Care respondents were more likely to identify the ED as the closest source of healthcare; report fewer symptom nights but a poorer quality of life; and describe the ED as a usual place for sick care, despite most having a PCP.Conclusions: Many children with asthma use the ED as a typical source of healthcare, and are distinguished by need for proximity, poorer caregiver QOL, and historic patterns of care-seeking. Efforts to improve timely access to outpatient care and reinforce the role of PCP-directed asthma management, such as through telemedicine, may reduce preventable morbidity including ED visits.
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