Panic and outpatient status explain high emergency care levels among poor urban asthmatic kids

April 23, 2007

Inner city children from poor families are much more likely to seek emergency care for asthma than their more affluent peers, finds research published ahead of print in Thorax.

But the reasons are not the expected culprits of damp housing, overcrowding, or living with a smoker, finds the study.

Rather, parents feeling panicky, previous outpatient visits, and a belief that emergency care would mean faster treatment, explain the figures, say the authors.

The findings are based on a comparison of asthmatic children registered at 164 family doctor practices in the three London boroughs of Lewisham, Southwark, and Lambeth. All three boroughs contain several areas of high deprivation.

A detailed analysis was made of the medical records of 1018 asthmatic children who had attended an emergency care department and 394 who had not, over a period of 12 months.

The children's parents provided background information on social and economic factors as well as explanations for their decisions to seek additional help for their children's worsening asthma symptoms.

The analysis revealed that children who sought emergency care came from poorer families.

And they were 13 times more likely to come to the emergency care department if they had already been to an outpatient clinic at the hospital during the previous year.

And they were more than twice as likely to be brought in if their parents felt anxious or panicky about their child's worsening symptoms.

A belief that the child would be seen more quickly in emergency care than in general practice also more than doubled the likelihood of a visit.

But faith in the family doctor's ability to effectively treat asthma attacks significantly lessened the likelihood.

There was no association found between seeking emergency care and overcrowded living conditions, damp housing, living with a smoker, or owning a pet.

BMJ Specialty Journals

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