REPORTED DIFFICULTIES IN ACCESS TO QUALITY CARE FOR CHILDREN WITH ASTHMA IN THE INNER-CITY

Objective: To characterize perceived access and barriers to quality he alth care for asthma among the caregivers of children in the inner cit y. Design: Multicenter, cross-sectional survey. Setting: Eight sites i n 7 major metropolitan US inner cities. Participants: A systematic sam ple of children with asthma, aged 4 to 9 years, and their caregivers w ho resided in census tracts in which at least 30% of the households we re below the 1990 federal poverty guidelines, recruited from 25 primar y care clinics and 13 emergency departments (EDs) from November 1, 199 2, through October 31, 1993. Results: Of the 1528 children enrolled, 1 376 had physician-diagnosed asthma and form the basis of this report. This group was further divided into 284 children (20.6%) who met all r ecruitment criteria for severe asthma and 207 (15.0%) with mild asthma who met none. Of parents in the total sample, 95.6% reported a usual place for short-term asthma care for their child; 75.4% used the ED. C hildren with severe asthma were significantly more likely to use the E D than those with mild asthma (84.3% vs 63.0%; P<.01). A usual place f or follow-up asthma care was reported by 96.7% of subjects. There were no differences in access or type of facility used by asthma severity. More than half the study group reported difficulty in accessing care for acute asthma attacks and for follow-up care with no differences by asthma severity. Among those with severe asthma, 47.5% used inhaled s teroids or cromolyn, 52.8% used a spacer device if they had been presc ribed a metered dose inhaler, and 21.2% of children older than 6 years were prescribed a peak flowmeter. Patients with mild asthma were sign ificantly less likely to report use of all 3 items (steroids or cromol yn, 1.4%; spacer device, 15.4%, and peak flowmeter, 3.1%, respectively ; P<.01). Conclusion: Although access to asthma care among children in US inner cities appears adequate as determined by the traditional mea sure of reporting a regular source of care, barriers are frequently re ported, as are deficiencies in the quality of medical care.