PURPOSE OF THE STUDY.
To identify common caregiver factors contributing to emergency department (ED) utilization for asthma care among inner city children.
One hundred and fifty children aged 3 to 12 years were recruited during an ED visit for acute asthma care. Inclusion criteria were physician-diagnosed persistent and uncontrolled asthma, 2 or more ED visits or 1 or more hospitalizations for asthma during the past year, and living in the Baltimore metropolitan area. Children were primarily African American (95%) with male predominance (64%) and a mean age of 6.4 years (SD 2.7 years), and the majority of caregivers were single mothers (85.2%).
After obtaining institutional review board approval, surveys were administered to caregivers during the initial ED visit to collect sociodemographic information, health characteristics including the child’s asthma symptoms, inhaler use, and perceived asthma control, as well as recent health care visits for asthma. Additionally, caregivers were asked to rank 11 items regarding their decision to use the ED for their child’s asthma care. Correlations among factors were identified by using cluster analysis.
Three clusters were identified in caregiver decision-making factors: urgency, preference for use of ED, and access to care issues. Urgency, primarily because of parental anxiety, was reported by 91% of caregivers. Urgent reasons were correlated with low controller medication use (P < .05). Thirty-seven percent reported preference for the ED based on trust and confidence in ED doctors, with a second ED visit within 3 months significantly more likely to occur in this cluster (odds ratio [OR] 3.7; P ≤ .5). Access to care issues were identified as significant factors in 31% of caregivers, notably the inability to get a same-day appointment with their primary care physician (PCP). Lack of health insurance was insignificant in caregiver decision-making, as 99% of the children reported insurance coverage.
The majority of caregivers indicated urgency as the most important reason in their decision to use the ED for asthma care, but preference for ED physicians and lack of same-day appointments with their PCP also played a significant role.
Asthma disproportionately affects low-income minority children, a population with high frequency ED use for asthma care. This study highlights important caregiver factors in this population that contribute to ED utilization and points to opportunities for targeted interventions. The correlation between both low income and low controller medication use with ED visits because of caregiver anxiety demonstrates the importance of providing resources and education to improve controller medication use leading to better asthma control and decreased reliance on ED visits for nonurgent care. Additionally, improved access and positive relationships with PCPs could play an important role in reducing ED visits.
- Copyright © 2017 by the American Academy of Pediatrics