Study objectives: To assess the roles of poor access to
care, psychological risk factors, and asthma severity in frequent
emergency department (ED) use.
Setting: Harlem Hospital
Center ED and outpatient chest clinic.
Three hundred seventy-five adult residents of Harlem, a predominantly
African-American community in New York City.
Measurements: Asthma severity was assessed by self-reported
symptoms using National Asthma Education and Prevention Program
guidelines, health-care utilization, and psychometric scales.
Results: Respondents with more severe asthma were more
likely to have a primary asthma care provider, and to have had more
scheduled office visits for asthma in the year prior to the interview
(mean number of visits for patients with severe asthma, 3.6 visits;
moderate asthma, 2.4 visits; and mild asthma, 1.7 visits). Despite
having a regular source of care, 69% of respondents identified the ED
as their preferred source of care; 82% visited the ED more than once
in the year prior to interview (median, four visits). Persons with
moderate or severe asthma were 3.8 times more likely to be frequent ED
users compared to those with mild asthma (odds ratio [OR], 3.8; 95%
confidence interval [CI], 2.2 to 6.6). This was the strongest
predictor of frequent ED use. Other predictors of ED use were number of
comorbid disorders (OR, 1.5; 95% CI, 1.1 to 2.1) and self-reported
global health in the year prior to the ED visit (OR, 1.8; 95% CI, 1.2
to 2.7). Psychological characteristics were not predictive of frequent
ED use when controlling for disease severity.
Conclusions: Frequent ED users present with serious medical
conditions. They do not substitute physician care with ED care; they
augment it to address serious health needs.