Emergency department use in asthmatic children in Puerto Rico

Among all children with asthma in the U.S., Puerto Rican children have the highest reported prevalence. Every year, 1 of 3 children with asthma visits the emergency department (ED) because of an asthma-related event. These visits cost five times that of primary care. The purpose of the study was to identify the factors associated with the use of the emergency department in asthmatic children of two low-income communities of Puerto Rico using Andersen's Behavioral Model of Health Care Use. This study uses a sample of 628 children that participated in the Allies Against Asthma Program Baseline Survey from April to October 2004. This Program was formed in response to the Allies Against Asthma request for proposals (RFP) and developed with collaboration between RAND and key stakeholders in Puerto Rico. Allies funding enabled the formation of the community-based coalition and the development of a comprehensive plan to address asthma. The factors that were associated (p <.05) with and increased risk of the use of the emergency room department were: exposure of Environmental Tobacco Smoke (OR = 1.62; 95%IC 1.05 – 2.51); age less than six year (OR = 1.56; 95%IC 1.02 – 2.37); asthma severity defined by frequency of asthma symptoms (OR = 2.18; 95%IC 1.09 – 4.35); parent perception of asthma severity (moderate: OR = 3.57; 95%IC 1.32 – 9.65, severe OR = 6.14; 95%IC 2.17 – 17.36 and very severe: OR = 8.21 95% IC 2.20 – 30.59) and place of residence (OR = 2.24 95%IC; 1.46 – 3.42). This information helps to identify patients at risk for emergency treatment, which is necessary in order to intervene more effectively and prevent costly emergency department use. In depth analysis of these results will be presented.