Exploring factors associated with asthma-related emergency department visits among adults: A path analysis approach

Background: Asthma is an expensive chronic lung disease that affects 7% of U.S. adults and results in as many as 1.8 million emergency department (ED) visits each year. Pharmacists play an important role in managing asthma, including assessing control and monitoring disease progression, educating the patient about the disease and associated treatments, and ensuring safe and cost-effective medication use. However, comprehensive studies that account for the complex relationships between factors impacting asthma-related ED visits are lacking in the adult asthma population. Objective: To explore the complex relationships between asthma control, medication use, co-morbid conditions, minority status, environment and asthma-related ED visits using a path analysis approach. Methods and materials: Data for this study were obtained from the 2012 Behavioral Risk Factor Surveillance System's Asthma Call Back Survey. Current asthmatics 18 and older were included in the sample. Path analysis was used to evaluate the direct effects of the independent variables on asthmarelated ED visits, as well as the indirect effects mediated through asthma control, health status, and daily use of inhaled corticosteroids. Results: Having controlled asthma (beta = -0.153, p < 0.01) and good health status (beta = -0.133, p < 0.01) were associated with significantly fewer ED visits. Good health status was associated with daily use of inhaled corticosteroids, which in turn was associated with better asthma control. Hispanic ED use was mediated by asthma control (beta = -0.067, p < 0.05), while African American ED use was mediated by health status (beta = 0.050, p < 0.05). Conclusion: These findings suggest that there may be race/ethnicity specific factors that may be targeted to reduce asthma-related ED visits in minority populations. (C) 2017 Elsevier Inc. All rights reserved.