Parental Perceptions of Access to Care and Quality of Care forInner-City Children with Asthma

Abstract

Dinkevich EI, Cunningham SJ, Crain EFJ Asthma.3519986371To describe perceptions of asthma care, morbidity, and health service utilization by parents of children with asthma presenting to an inner-city emergency department (ED).Parents of children (n = 466) receiving asthma treatment in an urban pediatric ED during a consecutive 6-week period in late fall 1995.Parents completed a 30-item survey including sociodemographic data, source of primary medical care and asthma care for their child, selected measures of access to care, and medications used by their child in the week before the ED visit. Perceived quality of asthma care was measured by six items reported to have been performed by the child's asthma doctor: discussion of home peak flow monitoring, triggers, dogs/cats, smoke, postexacerbation calling instructions, and provision of a written asthma management plan. Functional morbidity was measured by nights of poor sleep, days of cough, and school days missed because of asthma in the previous month.Of the patients surveyed, 325 had previously been diagnosed with asthma. Three hundred eight (97%) reported a source of primary medical care. The primary care provider (PCP) was identified as the child's usual source of asthma care (PCP users) in 126 respondents, while 158 identified the ED as the usual source of asthma care (ED users). The groups did not differ by insurance status, ethnicity, or mean age of the child. Thirty-nine percent of PCP users compared with 15% of ED users had used inhaled steroids or cromolyn in the week before the ED visit (P < .0001). PCP users had a higher mean quality score than ED users (3.7 vs 2.8; P< .0001), but there was no relationship between source of asthma care and functional morbidity.The ED remains the usual source of asthma care for many inner-city 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.High ED utilizers don't get the message: asthma is a chronic disease requiring 1) daily preventive management including trigger avoidance measures and antiinflammatory therapy, and 2) regular follow-up asthma care at least with the PCP, if not with an asthma specialist. How can we get this message through?