title: Impact of delay in asthma diagnosis on health care service use.
abstract: Delays in diagnosing asthma in children are common and are known to delay asthma-specific treatment. Few studies have investigated whether a delay in asthma diagnosis impacts the use of health care services. This study was designed to assess whether a delay in diagnosis of asthma influences the use of health care services. This was a retrospective cohort study with subjects elicited from a convenience sample of 839 healthy children. The criteria for asthma was met in 276 (33%) subjects; of these subjects 179 (65%) had a delay in the diagnosis of asthma and 97 (35%) had a timely diagnosis. Data on health care services (e.g., flu shot, availability of a peak flow meter, hospitalizations, and urgent care or emergency department visits) and the frequency of systemic steroid treatments were collected from medical records during the first 18 years of life. The frequencies of health service and use of systemic steroids were compared using Poisson and logistic regression models in asthmatic children with and without a delay in asthma diagnosis. Children with a delay in asthma diagnosis were more likely to visit urgent care centers at least once (40.8% versus 21.6%; p < 0.001), compared with those with a timely diagnosis. There were no significant differences in other health care service or systemic steroid use. A delay in the diagnosis of asthma was associated with an increase in urgent care visits suggesting suboptimal care. Clinicians should be aware that a delay in the diagnosis of asthma in children may result in the use of suboptimal health care services.
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Lynch
authors.forename: Chelsey A
authors.initials: CA
authors.lastname: Van Norman
authors.forename: Robert M
authors.initials: RM
authors.lastname: Jacobson
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: Young J
authors.initials: YJ
authors.lastname: Juhn
mesh_terms: D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014481:United States
references.citation: Allergy. 2008 Nov;63(11):1529-35
references.pmid: 18925889
references.citation: Environ Res. 2003 Jun;92(2):92-8
references.pmid: 12854688
references.citation: Pediatr Pulmonol. 2006 Apr;41(4):318-25
references.pmid: 16477658
references.citation: Allergy Asthma Proc. 2009 Jan-Feb;30(1):47-54
references.pmid: 19331719
references.citation: Ann Allergy Asthma Immunol. 2008 Jun;100(6):589-95
references.pmid: 18592824
references.citation: Arch Pediatr Adolesc Med. 2009 Feb;163(2):141-9
references.pmid: 19188646
references.citation: Pediatrics. 1993 Jan;91(1):56-61
references.pmid: 8416505
references.citation: Respir Med. 1990 Mar;84(2):139-42
references.pmid: 2371436
references.citation: N Engl J Med. 2001 Jun 28;344(26):2021-5
references.pmid: 11430334
references.citation: Pediatrics. 2003 May;111(5 Pt 1):1024-9
references.pmid: 12728083
references.citation: Pediatrics. 2003 May;111(5 Pt 1):1046-54
references.pmid: 12728087
references.citation: J Allergy Clin Immunol. 2009 Dec;124(6):1180-5
references.pmid: 20004779
references.citation: J Asthma. 2005 Sep;42(7):529-35
references.pmid: 16169784
references.citation: J Allergy Clin Immunol. 1999 Jan;103(1 Pt 1):54-9
references.pmid: 9893185
references.citation: Pediatr Pulmonol. 1999 Oct;28(4):297-300
references.pmid: 10497379
references.citation: BMC Pulm Med. 2005 May 10;5:7
references.pmid: 15885147
references.citation: AAOHN J. 2009 Sep;57(9):354
references.pmid: 19842610
references.citation: J Allergy Clin Immunol. 1991 Jul;88(1):89-95
references.pmid: 2071788
references.citation: J Asthma. 2007 Nov;44(9):753-8
references.pmid: 17994406
references.citation: Ann Epidemiol. 2005 Mar;15(3):214-8
references.pmid: 15723767
references.citation: Br Med J (Clin Res Ed). 1983 Apr 16;286(6373):1253-6
references.pmid: 6404413
references.citation: Am Rev Respir Dis. 1992 Oct;146(4):888-94
references.pmid: 1416415
references.citation: Sci Am. 1981 Oct;245(4):54-63
references.pmid: 7027437
references.citation: J Health Care Poor Underserved. 1999 Feb;10(1):27-44
references.pmid: 9989005
references.citation: J Allergy Clin Immunol. 2007 Dec;120(6):1468-9
references.pmid: 17981319