Accessing asthma care: a case study of urban children
The purpose of this exploratory, descriptive study was to identify factors that facilitate or impede the use of health care resources by urban children with asthma. Using an embedded case study design, the study considered the issue of health care access for urban children with asthma by focusing on attributes that impede and facilitate these children's access to health care resources. Interview, demographic, survey, and medical records data were analyzed for 34 parent-child dyads accessing asthma care in one metropolitan health care system. Interview data from 14 health care professionals were also analyzed. These findings were then compared with utilization data of 895 children accessing asthma care during 2003--2004, analyzed for significant access-related differences and predictive variables.; Both parent and health care professional participants identified a number of factors influencing children's access to asthma services, including parental beliefs, family organization, service organization, and insurance-related factors. Survey and medical records data confirmed many of these qualitative themes.; Utilization data analyses identified that age and race-related factors influence access to care. As children age, they had a reduced risk of having emergent/urgent visits and those who are Hispanic were less likely to have insurance. Insurance status was shown to influence access to care in that those who were uninsured were less likely to access allergy specialty services. In addition, those with Medicaid insurance also experience more insurance type changes. Insurance type changes were associated with a greater number of asthma related visits to all settings. Finally, a negative association was then found between asthma-related emergent/urgent care and primary care visits.; Among the many implications resulting from this study's findings was the seemingly strong influence clinical service organization and relationships between parents and providers have upon health care access patterns. Implications for nursing and recommendations for further research were also discussed.
Asthma -- Drug Therapy -- In Infancy and Childhood, Health Services Accessibility, Child, Family Relations, Health Beliefs, Insurance, Health, Reimbursement, Interviews, Medicaid, Parental Attitudes, Private Sector, Qualitative Studies, Record Review, Thematic Analysis, Urban Areas, Human
Published Article/Book Citation
, : (2006) pp.246 p-.