Restricted accessResearch articleFirst published online 2021-12
Effects of Rurality and Geographical Distance on Unplanned Emergency Department Utilization for Children With Asthma: A Population Level Retrospective Cohort Study
Asthma is a highly prevalent chronic disease among Ontario children; however, the extent to which rural status and distance are associated with unplanned emergency department (ED) use by this population is largely unknown.
Objective
To explore the impact of rurality and geographical distance to primary and specialist care services on healthcare utilization by analyzing the use of unplanned ED services.
Methods
A population level retrospective cohort study of Ontario children ages 5–14 with newly diagnosed asthma was conducted using health administrative data from Institute for Clinical Evaluative Sciences (ICES). Adjusted logistic regression models were used to analyze the association between unplanned ED use with rural status and distance to general practitioner/family physician (GP/FP) and specialist healthcare services, while controlling for confounders.
Results
In total, 19,732 individuals met the inclusion criteria. Individuals who lived in rural locations (OR 2.00, 95% CI 1.64–2.44) and travelled >50 km to a GP/FP (OR 1.25, 95% CI 1.06–1.48) or specialist (OR 1.20, 95% CI 1.05–1.38) were more likely to utilize an ED.
Conclusion
Children with asthma utilize healthcare services differently based on rural status and distance to services. To ensure equitable access to care, there is a need to accommodate for these factors in the planning and provision of asthma healthcare services.
Association of Women’s Health & Obstetric and Neonatal Nurses. (2017).
Access to health care: AWHONN position statement. Journal of Obstetric, Gynecologic & Neonatal Nursing,
46(1), 114–116. https://doi.org/10.1016/j.jogn.2016.11.005
DucharmeF. M.DellS. D.RadhakrishnanD.GradR. M.WatsonW. T. A.YangC. L.ZelmanM. (2015).
Diagnosis and management of asthma in preschoolers: A Canadian thoracic society and Canadian paediatric society position paper. Canadian Respiratory Journal,
22(3), 135–143. https://www.cps.ca/en/documents/position/asthma-in-preschoolers
GullifordM.Figueroa-MunozJ.MorganM.HughesD.GibsonB.BeechR.HudsonM. (2002).
What does ‘access to health care’ mean?Journal of Health Services Research & Policy,
7(3), 186–188. https://doi.org/10.1258/135581902760082517
8.
GuttmannA.ShipmanS. A.LamK.GoodmanD. C.StukelT. A. (2010).
Primary care physician supply and children’s health care use, access, and outcomes: Findings from Canada. Pediatrics,
125(6), 1119–1126. https://doi.org/10.1542/peds.2009-2821
9.
GuttmannA.ZagorskiB.AustinP. C.SchullM.RazzaqA.ToT.AndersonG. (2007).
Effectiveness of emergency department asthma management strategies on return visits in children: A population-based study. Pediatrics,
120(6), e1402–e1410. https://doi.org/10.1542/peds.2007-0168
LougheedM. D.GarveyN.ChapmanK. R.CicuttoL.DalesR.DayA. G.HopmanW. M.LamM.SearsM. R.SzpiroK.ToT.PatersonN. A. M. (2006).
The Ontario asthma regional variation study. Chest Journal,
129(4), 909–917. https://doi.org/10.1378/chest.129.4.909
13.
LudwickA.FuR.WardenC.LoweR. A. (2009).
Distances to emergency department and to primary care provider’s office affect emergency department use in children. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine,
16(5), 411–417. https://doi.org/10.1111/j.1553-2712.2009.00395.x
OuédraogoA.CrightonE. J.SawadaM.ToT.BrandK.LavigneE. (2018).
Exploration of the spatial patterns and determinants of asthma prevalence and health services use in Ontario using a Bayesian approach. PLoS One,
13(12), e0208205. https://doi.org/10.1371/journal.pone.0208205
PurdyS.GriffinT.SalisburyC.SharpD. (2011).
Emergency respiratory admissions: Influence of practice, population and hospital factors. Journal of Health Services Research & Policy,
16(3), 133–140. https://doi.org/10.1258/jhsrp.2010.010013
18.
SubediR.GreenbergT. L.RoshanafsharS. (2019).
Does geography matter in mortality? An analysis of potentially avoidable mortality by remoteness index in Canada. Health Reports,
30(5), 3–15. https://doi.org/10.25318/82-003-x201900500001-eng
19.
ToT.DellS.DickP. T.CicuttoL.HarrisJ. K.MacLuskyI. B.TassoudjiM. (2006).
Case verification of children with asthma in Ontario. Pediatric Allergy and Immunology,
17(1), 69–76. https://doi.org/10.1111/j.1399-3038.2005.00346.x
20.
ToT.StanojevicS.FeldmanR.MoineddinR.AtenafuE. G.GuanJ.GershonA. S., & RESPONSE Team. (2013).
Is asthma a vanishing disease? A study to forecast the burden of asthma in 2022. BMC Public Health,
13, 254. https://doi.org/10.1186/1471-2458-13-254
21.
ToT.ZhuJ.RyckmanK.GershonA. (2018).
Risk factors for return to emergency department for asthma: A population-based study. The Journal of Allergy and Clinical Immunology. In Practice,
6(6), 1907–1913. https://doi.org/10.1016/j.jaip.2018.04.016
22.
WechslerM. E. (2009).
Managing asthma in primary care: Putting new guideline recommendations into context. Mayo Clinic Proceedings,
84(8), 707–717. https://doi.org/10.1016/S0025-6196(11)60521-1
