Utilization of the emergency department as a routine source of care among children with asthma

Abstract

Objective: To describe characteristics of children with persistent asthma in the ED who receive most of their healthcare in emergency settings; and determine whether recent asthma experiences or historic patterns of care are associated with identifying the ED as a typical location for care.

Methods: We conducted a sub-analysis of baseline data from Telemedicine Enhanced Asthma Management through the Emergency Department (TEAM-ED), an RCT of children (3-12 years) presenting to the ED with persistent asthma (2016-2020). Caregivers identified reasons for seeking emergency care, including if their child received most overall healthcare in the ED (‘ED Care’; primary outcome) or not (‘Other Care’). Independent variables included demographics, recent symptoms and quality of life (QOL), and historic preventive care and healthcare use. We compared responses between ED Care and Other Care groups using bivariate and multivariate analyses.

Results: We analyzed data for 355 children (31% ED Care, 69% Other Care). Compared with Other Care, ED Care respondents were more likely to identify the ED as the closest source of healthcare; report fewer symptom nights but a poorer quality of life; and describe the ED as a usual place for sick care, despite most having a PCP.

Conclusions: Many children with asthma use the ED as a typical source of healthcare, and are distinguished by need for proximity, poorer caregiver QOL, and historic patterns of care-seeking. Efforts to improve timely access to outpatient care and reinforce the role of PCP-directed asthma management, such as through telemedicine, may reduce preventable morbidity including ED visits.

Keywords:

• Pediatrics
• emergency department
• asthma
• control/management
• prevention

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Trial registration

ClinicalTrials.gov identification number: NCT02752165

Additional information

Funding

This work was funded by a grant from the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (R01 HL091835). The funding source did not have a role in the study design; collection, analysis, or interpretation of data; writing of the report; or decision to submit the manuscript for publication.