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Reported difficulties in access to quality care for children with asthma in the inner city
E F Crain1, C Kercsmar, K B Weiss
1Department of Pediatrics, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY 10461, USA.
Insights
Inner-city children with asthma often face barriers to quality care, despite having a regular source. Many caregivers report difficulties accessing acute and follow-up asthma treatment.
Area of Science:
- Pediatric Pulmonology
- Public Health
- Health Services Research
Background:
- Asthma affects numerous children in urban environments, necessitating an understanding of their healthcare access.
- Inner-city populations often experience unique challenges in obtaining quality healthcare services.
Purpose of the Study:
- To assess the perceived access to and barriers of quality asthma care for children in inner-city settings.
- To identify disparities in care based on asthma severity and socioeconomic factors.
Main Methods:
- A multicenter, cross-sectional survey was conducted across seven major US inner cities.
- Systematic sampling included children aged 4-9 years with asthma and their caregivers from low-income households.
- Data were collected from primary care clinics and emergency departments between 1992 and 1993.
Main Results:
- Most caregivers reported a usual source for short-term (95.6%) and follow-up (96.7%) asthma care, with emergency departments (EDs) frequently used (75.4%).
- Children with severe asthma were more likely to use EDs (84.3%) than those with mild asthma (63.0%).
- Over half of caregivers reported difficulties accessing acute and follow-up care, irrespective of asthma severity; significant disparities in medication and device use were noted based on severity.
Conclusions:
- While access to a regular source of asthma care appears adequate in US inner cities, significant barriers to quality care persist.
- Deficiencies in medical care quality and access challenges require targeted interventions for urban pediatric asthma patients.
Objective:
To characterize perceived access and barriers to quality health care for asthma among the caregivers of children in the inner city.
Design:
Multicenter, cross-sectional survey.
Setting:
Eight sites in 7 major metropolitan US inner cities.
Participants:
A systematic sample of children with asthma, aged 4 to 9 years, and their caregivers who resided in census tracts in which at least 30% of the households were below the 1990 federal poverty guidelines, recruited from 25 primary care clinics and 13 emergency departments (EDs) from November 1, 1992, through October 31, 1993.
Results:
Of the 1528 children enrolled, 1376 had physician-diagnosed asthma and form the basis of this report. This group was further divided into 284 children (20.6%) who met all recruitment criteria for severe asthma and 207 (15.0%) with mild asthma who met none. Of parents in the total sample, 95.6% reported a usual place for short-term asthma care for their child; 75.4% used the ED. Children with severe asthma were significantly more likely to use the ED than those with mild asthma (84.3% vs 63.0%; P<.01). A usual place for follow-up asthma care was reported by 96.7% of subjects. There were no differences in access or type of facility used by asthma severity. More than half the study group reported difficulty in accessing care for acute asthma attacks and for follow-up care with no differences by asthma severity. Among those with severe asthma, 47.5% used inhaled steroids or cromolyn, 52.8% used a spacer device if they had been prescribed a metered dose inhaler, and 21.2% of children older than 6 years were prescribed a peak flowmeter. Patients with mild asthma were significantly less likely to report use of all 3 items (steroids or cromolyn, 1.4%; spacer device, 15.4%; and peak flowmeter, 3.1%, respectively; P<.01).
Conclusion:
Although access to asthma care among children in US inner cities appears adequate as determined by the traditional measure of reporting a regular source of care, barriers are frequently reported, as are deficiencies in the quality of medical care.