PARENTAL PERCEPTIONS OF ACCESS TO CARE AND QUALITY OF CARE FOR INNER-CITY CHILDREN WITH ASTHMA

The objective of this study was to describe perceptions of asthma care , morbidity, and health service utilization by parents of children wit h asthma presenting to an inner-city emergency department (ED). A cros s-sectional survey was conducted in an urban pediatric ED, with a conv enience sample of 466 parents of children receiving asthma treatment d uring a consecutive 6-week period in late fall 1995. Parents completed a 30-item survey including sociodemographic data, source of primary m edical care and asthma care for their child, selected measures of acce ss to care, and medications used by their child in the week prior to t he ED visit. Perceived quality of asthma care was measured by six item s (summary score = 0-6) reported to have been performed by the child's asthma doctor: discussion of home peak flow monitoring, child-specifi c triggers, dogs/cats, smoke, postexacerbation calling instructions, a nd provision of a written asthma management plan. Functional morbidity was measured by nights of poor sleep, days of cough, and school days missed due to asthma in the previous month. Among 325 patients with pr eviously diagnosed asthma, 308 (97%) were reported to have a source of primary medical care. Of these, 126 respondents identified their prim ary care provider as the child's usual source of asthma care, while 15 8 identified the ED as the usual source. The groups did not differ by insurance status, ethnicity or mean age of the child. Thirty-nine perc ent of children with the same provider for primary and asthma care com pared with 15% of children reported to receive their asthma care predo minantly in the ED had used inhaled steroids or cromolyn in the week p rior to the ED visit (p < .0001). Children with the same provider for primary and asthma care had a higher mean quality score than children receiving asthma care in the ED (3.7 vs. 2.8, p < 0.0001), but there w as no relationship between source of asthma care and functional morbid ity. The ED remains the usual source of asthma care for many inner-cit y children. Among parents surveyed in the ED, there was a significant relationship between source of usual asthma care and quality of care, but a relationship between usual source of asthma care and functional morbidity could not be identified.