ST. LOUIS—A recent study suggests that low-income urban parents would seek follow-up care for their asthmatic children after an emergency department (ED) visit if that care were easier to obtain.[1] Previous research has shown that although more than 90% of urban children have a source of primary medical care, approximately 75% of their families do not use it for asthma management. Instead, children are brought to the ED for care.

Sharon Smith, MD, Assistant Professor of Pediatrics at Washington University School of Medicine, St. Louis, told PULMONARY REVIEWS, “Most parents in our community view asthma as an episodic illness. They are aware that their child has asthma, but treatment is sought only when their child is symptomatic.”

Dr. Smith and colleagues created a questionnaire that covered parental perceptions of the pros and cons of follow-up care. It contained 41 statements considered to be reasons for or against seeking follow-up asthma care. One hundred forty-seven parents were asked to rate the statements on a scale of 1 to 5 (5 = “extremely important” and 1 = “not important”).

Statements were grouped into four categories: information pro, attitudinal pro, information con, and attitudinal con.

OBSTACLES TO SEEKING CARE

Results showed that barriers to care occur on many levels—both practical and ideological. For example, one parent may be influenced by his or her negative beliefs about the need for asthma care, whereas another may be influenced by logistical problems, such as finding transportation or a baby-sitter. Both of these cons, though unrelated, have the same negative effect on follow-up behavior.

Dr. Smith, who is also an emergency physician at St. Louis Children’s Hospital, noted that most primary care physicians are aware that parents have barriers to care. She adds, however, “I am not sure if they fully appreciate how this impacts a family’s ability or desire to seek follow-up or regular asthma care.”

Although the con items on this questionnaire were not given high ratings, the observed low level of follow-up care among this group suggests that parents do not know or appreciate the benefits of follow-up care. However, the high ratings given to the pro items suggest that parents believe that follow-up care can help their child.

WHAT’S A DOCTOR TO DO?

“I think the most important thing a primary care provider can do to improve follow-up visits is to educate the office staff about the importance of and need for follow-up care,” Dr. Smith remarked. “Many parents in our study reported that it was difficult to make an appointment on short notice, and some office staff told parents that if their child had no symptoms, they did not need to be seen.”

According to Dr. Smith, most ED physicians will treat a child’s acute symptoms and send the child home with appropriate instructions and medication for the next few days. This does not address long-term management, however. “How do parents treat the child’s asthma after the ED visit?” she asked. “Well, in our experience, most parents go back to treating the child as they did before the ED visit.”

Dr. Smith noted that if a child gets sick enough to require an ED visit, then there is a problem with that child’s home management plan or action plan. “A follow-up visit provides an opportunity to review the child’s medications and action plan as well as help educate the parents about early recognition of an impending exacerbation. This would help prevent another ED visit.”

—Gale Jurasek

Reference
1. Smith SR, Highstein GR, Jaffe DM, et al. Parental impressions of the benefits (pros) and barriers (cons) of follow-up care after an acute emergency department visit for children with asthma. Pediatrics. 2002;110:323-330.