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February 22, 2006
LOS ANGELES - A significant number of asthma sufferers wind up in the emergency room for treatment because delays for reasons such as cost or insurance coverage prevented them from getting earlier needed care, according to a study published this month in Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology.
Researchers found that while adults who delayed care and had daily or weekly asthma symptoms were most likely to visit the emergency room, these types of delays were also related to emergency room visits for those with less frequent symptoms as well.
Ying-Ying Meng, Dr.P.H., senior research scientist at the UCLA Center for Health Policy Research, Los Angeles, and colleagues studied 4,359 non-elderly adults who reported being diagnosed as having asthma and experiencing symptoms in the past year. Using data from the 2001 California Health Interview Survey (CHIS), they examined emergency room visits in the previous 12 months among those adult respondents with asthma.
Among asthma sufferers who experienced delays or did not get care because it cost too much or their insurance didn't cover it, 28 percent went to the emergency room. Twenty-three percent of those who delayed care for other reasons went to the emergency room for their asthma. Only 8 percent of those who experienced no delays at all went to the emergency room to treat their asthma.
The investigators observed that in the severe asthma group, Latinos and women were more likely to visit the emergency room, whereas in the group with less severe asthma, Asian, African American and uninsured adults were more likely to visit the emergency room.
"Two important factors related to emergency room visits for asthma, frequent asthma symptoms and delays in care for asthma, can be improved with effective interventions," write the authors. "If improvements can be made to access to quality asthma care and health care coverage, the number of emergency room visits for asthma care should significantly decline. Providers, patients and their family members should work in partnership to control asthma symptoms through more effective monitoring and medications. However, broader societal-level efforts are also needed, such as efforts to control asthma triggers (e.g., air pollution) and to improve health care coverage."
Carlos A. Camargo, M.D., Dr.P.H., associate professor of medicine & epidemiology at Harvard Medical School and Massachusetts General Hospital, Boston, notes in an accompanying editorial that there are signs of progress, but until we find a cure, there will continue to be emergency room visits for asthma care. Emergency room visits for asthma peaked in the late 1990s, and have stabilized despite the increases in both asthma prevalence and total emergency room visit volume.
"A critical component of access is timeliness, and for shortness of breath it is not enough to get an appointment with one's primary care physician or a specialist in a 'few days.' When people cannot breathe, they will continue to seek care in emergency rooms or other settings where they will be seen in minutes to hours and not days," Camargo writes.
Policymakers, health advocates, providers, researchers, and many others look to CHIS as an invaluable health policy tool. Conducted every two years, CHIS is a collaborative effort of the UCLA Center for Health Policy Research, the California Department of Health Services, and the Public Health Institute.
The UCLA Center for Health Policy Research was established in 1994 and is one of the nation's leading health policy research centers. It is also the premier source of key health policy information for California. The Center is based in the UCLA School of Public Health and is affiliated with the UCLA School of Public Affairs.
View the report:
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