Predictors of Frequent Emergency Department Utilization in Southeastern Pennsylvania

STUDY OBJECTIVE: We sought to determine socioeconomic and demographic factors that predict frequent emergency department (ED) use among asthmatics in Southeastern Pennsylvania. DESIGN: Retrospective cohort study using the 2004 Philadelphia Health Management Corporation's Southeastern Pennsylvania Household Health Survey. SETTING AND PARTICIPANTS: Health behaviors were surveyed using telephone interviews (random-digit dialing) in Bucks, Montgomery, Delaware, Philadelphia, and Chester counties. Response rate was 30%. RESULTS: Of 13,342 respondents, 1,799 (13%) stated that they had asthma. The mean reported visits in 12 months were as follows: clinic--1.2 (SD 2.7); doctor's office--4.7 (SD 5.6); ED--0.8; (SD 1.8); overnight hospitalizations--0.4 (SD 0.9). Most (91%) reported that a primary care doctor was their principal source of care, whereas 2% reported the ED as their principal source of care. Frequent ED use (>or=3 visits/12 months) was reported in 180 (10%). Frequent ED use was associated with race, education, diabetes, mental illness, smoking at home, and language barriers (p < 0.001) as well as indicators of severity of illness (clinic visits, office visits, prescription for asthma medication, p < 0.001). Using multivariable logistic regression, predictors of frequent ED use were: prescription for asthma meds (OR 2.3, 95%CI 1.4-3.7), having Medicaid or Medical Assistance (OR 1.7, 95%CI 1.1-2.6), having a high school education or less (OR 1.5, 95%CI 1.0-2.3), number of clinic visits (OR 1.1, 95% CI 1.1-1.1), office visits (OR 1.1, 95%CI 1.1-1.1), number of children living in the house (OR 1.2, 95% CI 1.0-1.3), and living in Philadelphia (OR 2.0, 95% CI 1.3-3.1). CONCLUSIONS: Frequent ED use is associated with demographic factors, geographic factors, and markers of severity of illness. While care guidelines recommend prompt referral to a primary care physician to prevent ED visits, given the level of primary care use in this population, frequent primary care attendance alone may not prevent asthma-related ED visits.