title: Parental decision making associated with pediatric emergency department use for asthma.
abstract: Disadvantaged minority children are disproportionately affected by asthma. This group is also known to frequently use the emergency department (ED) for asthma care. Understanding decisions for use of the ED is important to prevent high cost.
  
  
  
  To examine caregiver factors associated with the decision to use the ED for asthma care in inner-city children with asthma.
  
  
  
  One hundred fifty participants in a randomized clinical trial testing the effectiveness of a home-based asthma intervention were enrolled, and questionnaires were administered to caregivers during the child's ED asthma visit. Sociodemographics, health characteristic data, and caregiver interview data were examined to ascertain factors that affected caregiver decision making to use the ED for asthma care. A cluster analysis was performed to correlate caregiver reasons for the decision to use the ED for asthma care.
  
  
  
  Three clusters emerged for decision making: urgency, preference for the use of the ED, and access to care issues. The perception of urgency was the most common reason reported by caregivers (91%) followed by reporting a preference for the ED for care (37%) and reporting access to care issues (31%). Access to care was primarily attributable to the inability to get a same-day appointment with their primary care practitioner (24%).
  
  
  
  The caregiver factors involved in the decision to use the ED can provide a basis for further intervention and investigation. Such factors include caregiver asthma home management, improvement in relationships with primary care practitioners, and access to care-related issues.
authors: Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland. Electronic address: smudd1@jhu.edu.
authors: Shawna S
authors: SS
authors: Mudd
authors: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: C Jean
authors: CJ
authors: Ogborn
authors: Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.
authors: Mary Elizabeth
authors: ME
authors: Bollinger
authors: Morphew Consulting, Inc, Manhattan Beach, California.
authors: Tricia
authors: T
authors: Morphew
authors: Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland.
authors: Joan
authors: J
authors: Kub
authors: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Cassie
authors: C
authors: Lewis-Land
authors: University of Maryland School of Social Work, Baltimore, Maryland.
authors: Melissa H
authors: MH
authors: Bellin
authors: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors: Arlene
authors: A
authors: Butz
mesh_terms: D000328:Adult; D000420:Albuterol / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D014505:Urban Population; D055815:Young Adult
chemical_list: D001993:Bronchodilator Agents; D000420:Albuterol