title: Understanding frequent emergency room use by Medicaid-insured children with asthma: a combined quantitative and qualitative study.
abstract: BACKGROUND
  Medicaid-insured asthmatic children frequently use emergency rooms (ERs). The reasons are unclear and have predominantly been studied in inner-city populations.
  
  
  METHODS
  We used billing data and focus groups to clarify reasons for frequent ER use by Medicaid-insured children with asthma living in rural areas and 23 towns in Kansas.
  
  
  RESULTS
  High ER utilization was concentrated in a small percentage of provider practices and children with asthma. Parents expressed strong preference for primary care treatment, and identified real or perceived difficulties in using primary care as the principal reasons for ER use. Difficulties included trouble contacting primary care physicians or obtaining urgent appointments, limited continuity of care, practice systems poorly adapted to patient needs, a perception that physicians preferred patients to use emergency services, and difficulties in obtaining medications. Parents were not aware of preventive measures or case management but reported high interest in these. Parents did not recall provider discussion of asthma risk factors/preventive strategies during primary care visits, although all children with high ER utilization had multiple risk factors, including exposure to high levels of household smoking.
  
  
  CONCLUSIONS
  Reducing ER utilization by Medicaid-insured asthmatic children depends on overcoming barriers to effective treatment in primary care and in greater attention to preventive services.
authors.affiliation: Department of Preventive Medicine & Public Health, University of Kansas School of Medicine-Wichita, KS, USA. dfredric@kumc.edu
authors.forename: Doren D
authors.initials: DD
authors.lastname: Fredrickson
authors.forename: Craig A
authors.initials: CA
authors.lastname: Molgaard
authors.forename: S Edwards
authors.initials: SE
authors.lastname: Dismuke
authors.forename: Jay S
authors.initials: JS
authors.lastname: Schukman
authors.forename: Anne
authors.initials: A
authors.lastname: Walling
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000191:economics / Q000706:statistics & numerical data*; D001249:Asthma / Q000191:economics / Q000628:therapy*; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D017144:Focus Groups; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007615:Kansas; D008484:Medicaid / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012424:Rural Population; D014481:United States; D014505:Urban Population