Predictors of prior asthma specialist care among pediatric patients seen in the emergency department for asthma

Neha T. Agnihotri, Kathryn H. Pade, Sitaram Vangala, Lindsey R. Thompson, Vincent J. Wang, Sande O. Okelo

Research output: Contribution to journalArticle

Abstract

Background: Asthma guidelines recommend specialist care for patients experiencing poor asthma outcomes during emergency department (ED) visits. The prevalence and predictors of asthma specialist care among an ED population seeking pediatric asthma care are unknown. Objective: To examine, in an ED population, factors associated with prior asthma specialist use based on parental reports of prior asthma morbidity and asthma care. Methods: Parents of children ages 0 to 17 years seeking ED asthma care were surveyed regarding socio-demographics, asthma morbidity, asthma management and current asthma specialist care status. We compared prior asthma care and morbidity between those currently cared for by an asthma specialist versus not. Multivariable logistic regression models to predict factors associated with asthma specialist use were adjusted for parent education and insurance type. Results: Of 150 children (62% boys, mean age 4.7 years, 69% Hispanic), 22% reported asthma specialist care, 75% did not see a specialist and for 3% specialist status was unknown. Care was worse for those not seeing a specialist, including under-use of controller medications (24% vs. 64%, p < 0.001) and asthma action plans (20% vs. 62%, p < 0.001). Multivariable logistic regression revealed that lack of recommendation by the primary care physician reduced the odds of specialist care (OR 0.01, 95% CI <0.01, 0.05, p < 0.001). Conclusions: Asthma specialist care was infrequent among this pediatric ED population, consistent with the sub-optimal chronic asthma care we observed. Prospective trials should further investigate if systematic referral to asthma specialists during/after an ED encounter would improve asthma outcomes.

Original languageEnglish (US)
Pages (from-to)816-822
Number of pages7
JournalJournal of Asthma
Volume56
Issue number8
DOIs
StatePublished - Aug 3 2019
Externally publishedYes

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Hospital Emergency Service
Asthma
Pediatrics
Logistic Models
Morbidity
Population
Primary Care Physicians
Insurance
Hispanic Americans

Keywords

  • control/management
  • Morbidity and mortality
  • pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine

Cite this

Predictors of prior asthma specialist care among pediatric patients seen in the emergency department for asthma. / Agnihotri, Neha T.; Pade, Kathryn H.; Vangala, Sitaram; Thompson, Lindsey R.; Wang, Vincent J.; Okelo, Sande O.

In: Journal of Asthma, Vol. 56, No. 8, 03.08.2019, p. 816-822.

Research output: Contribution to journalArticle

Agnihotri, Neha T. ; Pade, Kathryn H. ; Vangala, Sitaram ; Thompson, Lindsey R. ; Wang, Vincent J. ; Okelo, Sande O. / Predictors of prior asthma specialist care among pediatric patients seen in the emergency department for asthma. In: Journal of Asthma. 2019 ; Vol. 56, No. 8. pp. 816-822.
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abstract = "Background: Asthma guidelines recommend specialist care for patients experiencing poor asthma outcomes during emergency department (ED) visits. The prevalence and predictors of asthma specialist care among an ED population seeking pediatric asthma care are unknown. Objective: To examine, in an ED population, factors associated with prior asthma specialist use based on parental reports of prior asthma morbidity and asthma care. Methods: Parents of children ages 0 to 17 years seeking ED asthma care were surveyed regarding socio-demographics, asthma morbidity, asthma management and current asthma specialist care status. We compared prior asthma care and morbidity between those currently cared for by an asthma specialist versus not. Multivariable logistic regression models to predict factors associated with asthma specialist use were adjusted for parent education and insurance type. Results: Of 150 children (62{\%} boys, mean age 4.7 years, 69{\%} Hispanic), 22{\%} reported asthma specialist care, 75{\%} did not see a specialist and for 3{\%} specialist status was unknown. Care was worse for those not seeing a specialist, including under-use of controller medications (24{\%} vs. 64{\%}, p < 0.001) and asthma action plans (20{\%} vs. 62{\%}, p < 0.001). Multivariable logistic regression revealed that lack of recommendation by the primary care physician reduced the odds of specialist care (OR 0.01, 95{\%} CI <0.01, 0.05, p < 0.001). Conclusions: Asthma specialist care was infrequent among this pediatric ED population, consistent with the sub-optimal chronic asthma care we observed. Prospective trials should further investigate if systematic referral to asthma specialists during/after an ED encounter would improve asthma outcomes.",
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