Objective: To identify risk factors for emergency department (ED) use among children with asthma using primary care in a managed care environment.
Design: Using automated data sources, children with asthma were identified and followed for 2-year periods. We fit logistic regression models using generalized estimating equation approaches to identify ED risk factors.
Patients: Children with asthma aged 5-14 with a visit to a pediatrician practicing with a large group practice and enrolled in an HMO for 2 consecutive years between 1992 and 1996 (N = 411 children).
Main outcome measures: Asthma-related ED use.
Results: Twenty-three percent of children incurred an asthma-related ED visit. Asthma-related ED use was greater among children with prior asthma-related ED use (OR [odds ratio] = 8.26, 95% CI [confidence interval] = 4.79-14.25), decreased with increasing age (OR = 0.87, 95% CI = 0.79-0.96) and frequency of visits to a primary care physician for asthma (OR = 0.82, 95% CI = 0.70-0.96), and tended to be less among children who saw an allergist (OR = 0.59, 95% CI = 0.33-1.04). No significant relationship was found between asthma-related ED use and race, household income, or other patient characteristics.
Conclusions: Targeting children with prior asthma-related ED use and encouraging routine primary care visits as well as the use of an allergist may afford opportunities to reduce ED use among children with asthma currently receiving primary care.