Spatial accessibility of primary care pediatric services in an urban environment: association with asthma management and outcome.

BACKGROUND: Disadvantaged urban children with asthma depend heavily on emergency departments (EDs) for episodic care. We hypothesized that among an urban population of children with asthma, higher spatial accessibility to primary care pediatric services would be associated with (1) more scheduled primary care visits for asthma, (2) better longitudinal asthma management, and (3) fewer unscheduled visits for asthma care.
METHODS: We enrolled children aged 12 months to 17 years, inclusive, who sought acute asthma care in an urban pediatric ED. Eligibility criteria included a history of unscheduled visits for asthma in the previous year. We collected comprehensive data on each participant's asthma medical management and prior health care utilization. In addition, we calculated each participant's spatial accessibility to primary care pediatric services, reported as a provider-to-population ratio at their place of residence. Patients then were stratified by their spatial accessibility to care and compared with respect to measures of medical management and health care utilization.
RESULTS: Among the 411 eligible participants, the spatial accessibility of primary care ranged from 7.4 to 350.2 full-time pediatric providers per 100,000 children <18 years of age, with a mean of 57.7 +/- 40.0. Patients in the middle and highest tertiles of spatial accessibility made significantly more scheduled visits for asthma care than patients in the lowest tertile. There were no differences among tertiles of accessibility with respect to asthma management or with respect to unscheduled visits for asthma care.
CONCLUSIONS: Within this highly urban, largely disadvantaged and minority population of children with chronic asthma, patients with higher spatial accessibility to primary care services made significantly more scheduled visits for asthma care.