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Reported Difficulties in Access to Quality Care for Children With Asthma in the Inner City
Ellen F. Crain, MD, PhD;
Carolyn Kercsmar, MD;
Kevin B. Weiss, MD;
Herman Mitchell, PhD;
Henry Lynn, PhD
Arch Pediatr Adolesc Med. 1998;152:333-339.
Objective To characterize perceived access and barriers to quality health care for asthma among the caregivers of children in the inner city.
Design Multicenter, cross-sectional survey.
Setting Eight sites in 7 major metropolitan US inner cities.
Participants A systematic sample of children with asthma, aged 4 to 9 years, and their caregivers who resided in census tracts in which at least 30% of the households were below the 1990 federal poverty guidelines, recruited from 25 primary care clinics and 13 emergency departments (EDs) from November 1, 1992, through October 31, 1993.
Results Of the 1528 children enrolled, 1376 had physician-diagnosed asthma and form the basis of this report. This group was further divided into 284 children (20.6%) who met all recruitment 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. Children with severe asthma were significantly more likely to use the ED than those with mild asthma (84.3% vs 63.0%; P<.01). A usual place for 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 steroids or cromolyn, 52.8% used a spacer device if they had been prescribed a metered dose inhaler, and 21.2% of children older than 6 years were prescribed a peak flowmeter. Patients with mild asthma were significantly less likely to report use of all 3 items (steroids or cromolyn, 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 measure of reporting a regular source of care, barriers are frequently reported, as are deficiencies in the quality of medical care.
From the Departments of Pediatrics, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY (Dr Crain); Case Western Reserve University School of Medicine, Cleveland, Ohio (Dr Kercsmar); The Center for Health Services Research, Rush Medical College, Chicago, Ill (Dr Weiss); and The New England Research Institute, Watertown, Mass (Drs Mitchell and Lynn). Dr Mitchell is now affiliated with Rho Inc, Chapel Hill, NC.
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