Relationship between pediatric primary provider visits and acute asthma ED visits.
OBJECTIVE
The purpose of this study is to evaluate the relationship between primary care provider visits and emergency department (ED) asthma visits for urban, minority children.


METHODS
This is a retrospective review of eligibility files and Medicaid claims for children with asthma from 1999 to 2001.


METHODS
Children 24 months through 17 years of age with Medicaid or state health insurance, who resided in Hartford, Connecticut, and had persistent asthma, were included.


METHODS
The primary outcome was the number of ICD-9 asthma-related primary care visits in the 12-month period before asthma ED visits. Secondary outcomes included the number of filled prescriptions for controller medications 3 and 12 months before emergency asthma visits.


RESULTS
One thousand four hundred seventy-four children met study criteria. Children with a greater number of asthma-related primary care visits during the previous 12 months were less likely to have asthma-related ED visits in 2000 and 2001 (both years P < 0.001). Children with an asthma-related ED visit had fewer primary care visits (for any reason) in 2000 but not in 2001 (P < 0.01). In 2000, the odds that children with 3 or more asthma-related primary care visits and a filled inhaled corticosteroid (ICS) had an asthma ED visit were 1/5 those of children with fewer asthma-related PCP visits or no filled ICS (OR = 0.20, 95% CI (0.06, 0.65)). Fewer than 17% of all children with asthma-related ED visits filled any prescription for controller medications in the 3 months before these visits.


CONCLUSIONS
Asthma-related primary care visits are associated with fewer asthma-related ED visits in urban children.
Smith
Sharon R
SR
Division of Emergency Medicine, Department of Pediatrics, University of Connecticut School of Medicine, Connecticut Children's Medical Center, Hartford, Connecticut, USA. srsmith@ccmckids.org
Wakefield
Dorothy B
DB
Cloutier
Michelle M
MM
D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003237:Connecticut; D003266:Continuity of Patient Care; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008484:Medicaid; D010349:Patient Compliance; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014505:Urban Population
D018927:Anti-Asthmatic Agents