Abstract 477 Pulmonary: Reactive Airway Diseases I Poster Symposium, Monday, 5/3

Background and Objectives: Regular care reduces asthma morbidity, which is highest among low-income urban children. The rates of return for regular care after an acute asthma ED visit are dismal, as low as 6-10%. In an effort to improve adherence to regular asthma care, we studied the perceived advantages (Pros) and barriers (Cons) to regular asthma care among parents of urban poor children with asthma. Methods: We enrolled a convenience sample of parents whose children came to our ED for treatment of acute asthma. Inclusion criteria were parents of children aged 2-12 years who had Medicaid or no medical insurance. Parents of children who had another chronic illness were excluded. Forty-one items were developed from parent focus groups and clinical experience (22 Pros and 19 Cons). One of 2 trained persons administered the questionnaire to parents, who rated the importance (on a 5 point scale) of each item in their decision to obtain a follow-up visit. Principle Components Analysis was used to analyze the data. Results: Ninety-three subjects were enrolled. Twenty-three items were highly associated with obtaining a follow-up visit. The Pros scale of 10 items (loading 0.55-0.73, α 0.82) included: obtaining information about triggers, allergies, medications; education for child's school, family members; action plans; and parental belief that children are "healthier" from regular care. The Cons scale of 13 items (loading 0.53-0.66, α 0.72) included: difficulties with transportation, sibling child care, missing time from work, and parental beliefs that family can give good asthma advice, and children should see the doctor only if "sick". Eighteen items were not associated with a follow-up visit, 12 Pros (such as the chance to ask questions, medications for school, and "approval" from family or doctor) and 6 Cons (including difficulty in "getting" the appointment and missing school). Conclusions: Twenty-three Pros and Cons are associated with obtaining follow-up after an acute asthma ED visit. We predict that programs which target these Pros and Cons are likely to improve adherence to regular care for low-income urban children with asthma.

Funded by National Heart, Lung, and Blood Institute of the National Institutes of Health Grant HL57232-01A2 "Asthma and Interventions in the Emergency Department"