Access to care among children visiting the emergency room with acute exacerbations of asthma
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A E Davidson1, D E Klein, G A Settipane
1Department of Allergy and Clinical Immunology, Rhode Island Hospital, Providence.
Insights
Pediatric asthma patients on Medicaid face barriers to preventive care, leading to increased emergency room use. This highlights disparities in healthcare access for vulnerable populations.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Health Equity
Background:
- Emergency room (ER) utilization for acute asthma exacerbations in children can indicate gaps in regular care.
- Understanding factors influencing ER use is crucial for improving asthma management in pediatric populations.
Purpose of the Study:
- To investigate disparities in access to continuing and preventive care for pediatric asthma patients who use the ER.
- To identify socioeconomic and demographic factors associated with ER reliance for asthma exacerbations.
Main Methods:
- Prospective survey of 170 families of pediatric asthma patients (ages 2-17) treated in the ER.
- Data collected on socioeconomic factors, primary/specialty care access, medication use, and asthma management plans.
- Logistic regression analysis to identify predictors of ER use and access to preventive care.
Main Results:
- While most patients identified a primary care source, 27% used regular preventive therapy and 35% had allergy evaluations.
- Patients identifying "Come to ER" as their sole management plan were common (20%).
- Black and Hispanic patients, and those with Medicaid, were less likely to contact their physician before ER visits and more likely to have multiple ER visits.
Conclusions:
- Patients with Medicaid face significant barriers to accessing continuing and preventive asthma care.
- Disparities in care access contribute to higher emergency room utilization among vulnerable pediatric asthma patients.
- Targeted interventions are needed to improve primary and preventive care access for underserved pediatric asthma populations.
Abstract:
To determine differences in access to continuing and preventive care among pediatric patients utilizing the emergency room for treatment of acute exacerbation of asthma, families of 170 asthma patients aged 2 to 17 years were surveyed prospectively. An interview schedule instrument generated information about socioeconomic factors, source of medical care including maintenance and specialty care, medication use, and plans for management of asthma exacerbations. A primary physician or clinic could be identified by 162 patients (95%). Regular preventive therapy (cromolyn, theophylline, or steroids) was used by 45 patients (27%). Allergy evaluations had been previously performed for 59 patients (35%). "Come to Emergency Room" was part of the asthma management plan for 56 patients (33%) and was the only asthma management plan for 34 patients (20%). Logistic regression analysis found that black and Hispanic patients (odds ratio = 0.38) and patients with Medicaid (odds ratio = 0.43) were less likely to call their MD or clinic prior to reporting to the emergency room. Patients with Medicaid were more likely to have two or more prior emergency room visits compared with a group of patients with private insurance and self-paying patients (odds ratio = 4.17). While the majority of patients in this study could identify a source of primary care, patients on Medicaid were significantly less likely to access continuing and preventive care and more likely to utilize the emergency room.