The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #66923

April A. Greek, PhD¹, Gail M. Kieckhefer, ARNP, PhD², Hyoshin H. Kim, PhD¹, Jutta M. Joesch, PhD¹, and Nazli Baydar, PhD³. (1) Battelle Centers for Public Health Research & Evaluation, 4500 Sand Point Way, NE, Seattle, WA 98105, 206-528-3167, greeka@battelle.org, (2) Family & Child Nursing, University of Washington, Box 357262, Seattle, WA 98195, (3) Psychology & Sociology, Koc University, Rumelifeneri Yolu, Istambul, Turkey

Objectives: Effective management of childhood asthma requires a usual source of care that is accessible, comprehensive, and coordinated. This study examines disparities in characteristics of the usual source of care (USC) for children with asthma. Methods: We use data from the 1996/1998/1999 Medical Expenditure Panel Survey (MEPS), a nationally representative in-person survey of the US population. Data for children age 0-17 years were provided by the most knowledgeable adult living in the home and providing care for the child. We selected children reported to have asthma (n=1,311), and distinguish Hispanic (n=377), black (n=301), and white/other (n=633) children. We categorized family income by poverty level: <100% (n=397), 100-199% (n=345), 200-399% (n=338), and ³400% (n=231). Bivariate associations were tested with Pearson chi-square. Multivariate estimates were calculated with logistic regression and include: family poverty level, and child's race-ethnicity, age, gender, and insurance status. Statistics were weighted to adjust for the complex sampling design of MEPS. Results: White and Hispanic children were more likely to than black children report a USC (95%, 94%, 90%, respectively). White children were also more likely than Hispanic or black children to have had private insurance at some point over the calendar year (76%, 44%, 37%), to identify a specific physician as the USC (54%, 39%, 42%), to usually have appointments (77%, 60%, 61%), and to expect to wait <31 minutes with an appointment (85%, 70%, 80%). Compared to children at ³400% poverty, those at <100% were less likely to have private insurance (94% vs 19%), a USC (96% vs 91%), usual physician (60% vs 46%), usually have appointments (81% vs 62%), and expect to wait <31 minutes (89% vs 69%). The following did not differ by race-ethnicity or income groups: how difficult to get appointment on short notice; USC listens and provides information; confident in provider's ability; satisfaction with USC professional staff; and, overall satisfaction with quality of care at the USC. Selected multivariate results include the following. Having no USC was related to absence of private insurance, but not race-ethnicity or income. Among children with a USC, identifying a usual physician continued to be associated with race-ethnicity and income. Expected wait times of 31+ minutes continued to be significantly higher among Hispanics and poor/near poor families, but not for blacks. Conclusions: Analysis identified disparities in structural characteristics of the USC by race-ethnicity and income. We found no differences regarding perceptions of satisfaction and communication with the USC.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to:
• Outline the characteristics of the usual source of care among children with asthma.
• List differences in the usual source of care by race-ethnicity and family income among children with asthma.
• Articulate the implications of these differences in the usual source of care on asthma management.

Keywords: Access to Health Care, Asthma

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.