Ae. Davidson et al., ACCESS TO CARE AMONG CHILDREN VISITING THE EMERGENCY ROOM WITH ACUTE EXACERBATIONS OF ASTHMA, Annals of allergy, 72(5), 1994, pp. 469-473
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.