title: "No other choice": reasons for emergency department utilization among urban adults with acute asthma.
abstract: OBJECTIVE
  Asthma is considered "ambulatory care-sensitive," yet emergency department (ED) visits remain common. Few studies have examined how ED asthma patients choose their sites of urgent care. The authors explored reasons for asthma-related ED use among adults.
  
  
  METHODS
  From May to September 2012, semistructured qualitative interviews were conducted with a convenience sample of patients visiting a high-volume urban ED for asthma. A piloted interview guide was used; it had open-ended questions derived from clinical experience and a focus group of asthmatic adults who frequently use the ED for care. Interviews were conducted until theme saturation was reached. Interview transcripts and field notes were entered into NVivo 10 and double-coded, using an iterative process to identify patterns of responses, ensure reliability, examine discrepancies, and achieve consensus through content analysis.
  
  
  RESULTS
  Patients view their asthma symptoms in two categories: those they can manage at home and those requiring a provider's attention. Preferred site of acute asthma care varied, but most patients felt that they had little choice for acute exacerbations. Specific reasons for ED visits included wait times, acuity, insurance status, ED resources/expertise, lack of symptom improvement, lack of asthma medication, inability to access outpatient provider, referral by outpatient provider, and referral by friend or family member.
  
  
  CONCLUSIONS
  Barriers to urgent outpatient care may contribute to ED use for asthma. Additionally, patients with asthma exacerbations may not recognize a need for provider attention until the need is urgent. Efforts to identify patients with acute asthma early and to increase access to urgent outpatient care may reduce asthma-related ED visits.
authors.affiliation: Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Charlotte C
authors.initials: CC
authors.lastname: Lawson
authors.forename: Kate
authors.initials: K
authors.lastname: Carroll
authors.forename: Rodalyn
authors.initials: R
authors.lastname: Gonzalez
authors.forename: Chantel
authors.initials: C
authors.lastname: Priolo
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Apter
authors.forename: Karin V
authors.initials: KV
authors.lastname: Rhodes
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001249:Asthma / Q000628:therapy*; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D013997:Time Factors; D014505:Urban Population; D055815:Young Adult