Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. S78-S85 (doi:10.1542/peds.2005-2000E)
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SUPPLEMENT ARTICLE

Spatial Accessibility of Primary Care Pediatric Services in an Urban Environment: Association With Asthma Management and Outcome

Stephen J. Teach, MD, MPHa,b, Mark F. Guagliardo, PhDb, Ellen F. Crain, MD, PhDc, Robert J. McCarter, ScDd, Deborah M. Quint, BAe, Cheng Shao, MPHd and Jill G. Joseph, MD, PhDb

a Division of Emergency Medicine
d Bioinformatics and Biostatistics Unit, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
b Center for Health Services and Community Research, Children's Research Institute, Children's National Medical Center, George Washington University School of Public Health and Health Services, Washington, DC
c Division of Emergency Medicine, Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
e Center for Health Services and Community Research, Children's Research Institute, Children's National Medical Center, Washington, DC

BACKGROUND. Disadvantaged urban children with asthma depend heavily on emergency departments (EDs) for episodic care. We hypothesized that among an urban population of children with asthma, higher spatial accessibility to primary care pediatric services would be associated with (1) more scheduled primary care visits for asthma, (2) better longitudinal asthma management, and (3) fewer unscheduled visits for asthma care.

METHODS. We enrolled children aged 12 months to 17 years, inclusive, who sought acute asthma care in an urban pediatric ED. Eligibility criteria included a history of unscheduled visits for asthma in the previous year. We collected comprehensive data on each participant's asthma medical management and prior health care utilization. In addition, we calculated each participant's spatial accessibility to primary care pediatric services, reported as a provider-to-population ratio at their place of residence. Patients then were stratified by their spatial accessibility to care and compared with respect to measures of medical management and health care utilization.

RESULTS. Among the 411 eligible participants, the spatial accessibility of primary care ranged from 7.4 to 350.2 full-time pediatric providers per 100000 children <18 years of age, with a mean of 57.7 ± 40.0. Patients in the middle and highest tertiles of spatial accessibility made significantly more scheduled visits for asthma care than patients in the lowest tertile. There were no differences among tertiles of accessibility with respect to asthma management or with respect to unscheduled visits for asthma care.

CONCLUSIONS. Within this highly urban, largely disadvantaged and minority population of children with chronic asthma, patients with higher spatial accessibility to primary care services made significantly more scheduled visits for asthma care.

Key Words: asthma management • urban children • health care accessibility

Abbreviations: NHLBI—National Heart, Lung, and Blood Institute • PCP—primary care provider • ED—emergency department • SA—spatial accessibility • CNMC—Children's National Medical Center • FTE—full-time equivalent • OR—odds ratio • CI—confidence interval • RR—relative risk

Accepted Dec 6, 2005.