ACCESS TO CARE AMONG CHILDREN VISITING THE EMERGENCY ROOM WITH ACUTE EXACERBATIONS OF ASTHMA

To determine differences in access to continuing and preventive care a mong pediatric patients utilizing the emergency room for treatment of acute exacerbation of asthma, families of 170 asthma patients aged 2 t o 17 years were surveyed prospectively. An interview schedule instrume nt generated information about socioeconomic factors, source of medica l care including maintenence and specialty care, medication use, and p lans for management of asthma exacerbations. A primary physician or cl inic could be identified by 162 patients (95%). Regular preventive the rapy (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 ofthe asthma management pla n for 56 patients (33%) and was the only asthma management plan for 34 patients (20%). Logistic regression analysis found that black and His panic patients (odds ratio = 0.38) and patients with Medicaid (odds ra tio = 0.43) were less likely to call their MD or clinic prior to repor ting 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 uti lize the emergency room.