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.
DESIGN: This is a retrospective review of eligibility files and Medicaid claims for children with asthma from 1999 to 2001. PARTICIPANTS: 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. OUTCOME MEASURES: 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.
CONCLUSION: Asthma-related primary care visits are associated with fewer asthma-related ED visits in urban children. (c) 2007 Wiley-Liss, Inc.