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PEDIATRICS Vol. 110 No. 2 August 2002, pp. 323-330

Parental Impressions of the Benefits (Pros) and Barriers (Cons) of Follow-up Care After an Acute Emergency Department Visit for Children With Asthma

Sharon R. Smith, MD^*, Gabrielle R. Highstein, PhD, David M. Jaffe, MD^*, Edwin B. Fisher, Jr, PhD, Robert C. Strunk, MD

^* Division of Emergency Medicine
Division of Allergy and Pulmonary Medicine, Department of Pediatrics, St Louis Children’s Hospital, St Louis, Missouri
Division of Health Behavior Research, Departments of Pediatrics and Medicine, Washington University School of Medicine, St Louis, Missouri

Objective. Asthma morbidity, with increasing emergency department (ED) visits, is prevalent among low-income, urban children. Follow-up care after ED visits is infrequent. We developed and evaluated an instrument that describes the parental benefits (pros) and barriers (cons) of obtaining follow-up care for interventions to promote follow-up.

Methods. We enrolled a convenience sample of low-income, urban parents who brought their children to the ED for treatment of asthma. These parents rated 41 items about the pros and cons of making a follow-up visit. Principal component analysis was used to identify the underlying structure of the instrument.

Results. One hundred forty-seven participants were interviewed in the ED. Principal component analysis retained 24 total items, which were identified by this sample as highly associated with deciding to take their child to a follow-up visit. Two types of pros were identified, informational and attitudinal, including "ask the doctor questions," and " children with asthma are healthier if they see their doctor regularly." Two types of cons were identified, practical and attitudinal, including "I have to find transportation," and "I don’t need to see the doctor unless my child is sick." The mean total pro and con scores were 4.05 ± 0.63 and 1.73 ± 0.67, respectively.

Conclusions. The pros and cons are not unidimensional. Even among those with infrequent follow-up, pros were endorsed more highly than cons. Programs that target these pros and cons may improve adherence to follow-up and regular care for low-income urban children.

Key Words: asthma • emergency department • follow-up • benefits and barriers • pros and cons

Abbreviations: ED, emergency department • PCP, primary care provider

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Received for publication Sep 14, 2001; Accepted Feb 13, 2002.

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