50 JSPN Vol. 9, No. 2, April-June, 2004 Accepted for publication June 2, 2003. Andrea Wallace, Jill Scott, Mary Klinnert, and Mark E. Anderson Andrea Wallace, ND, RN, is a PhD candidate, University of Colorado Health Sciences Center School of Nursing; Jill Scott, PhD, RN, is Assistant Professor, University of Colorado Health Sciences Center School of Nursing; Mary Klinnert, PhD, is Associate Professor, Department of Pediatrics, National Jewish Medical and Research Center; and Mark E. Anderson, MD, is a pediatrician, Department of Community Health Services, Denver Health and Hospital, and Assistant Professor, University of Colorado Health Sciences Center School of Medicine, Denver, CO. Asthma is the most common childhood illness and, despite advances in asthma management, morbidity and mortality rates are rising (Centers for Disease Control and Prevention, 1998; Tartasky, 1999). Latest estimates project asthma expenditures of at least $12.7 billion an- nually (Public Health Policy Advisory Board, 2002). Many factors seem to contribute to asthma morbidity, in- cluding race and ethnicity, socioeconomic status, urban dwelling, severe disease, prior emergency room visits, psychological problems, and treatment nonadherence. Urban, impoverished, minority children contribute dis- proportionately to the trend of increasing asthma mor- bidity and mortality (Aligne, Auinger, Byrd, & Weitz- man, 2000; Bartlett et al., 2001; Miller, 2000). Urban impoverished children with asthma, regardless of payor source, access costly emergency services more frequently than do their nonurban counterparts (Halfron & Newacheck, 1993; Lozano, Connell, & Koepsell, 1995; Ortega et al., 2001). Children with Medicaid are likely to report a usual source of routine care but are less likely to receive care in a primary care office or to have continuity between care sources (Crain, Kercsmer, Weiss, Mitchell, & Lynn, 1998; Halfron & Newacheck; Kattan et al., 1997). In a recent study, 75.4% of parents of urban asthmatic children cited the emergency department (ED) as their usual source of care (Crain et al.). This reliance on emer- gency care services appears to play a role in rising asthma morbidity among urban children because those frequently accessing emergency care also have fewer vis- its to primary care providers and are less likely to fill pre- Impoverished Children With Asthma: A Pilot Study of Urban Healthcare Access ISSUES AND PURPOSE. Using Andersens Behavioral Model of Health Care Use, this pilot study was conducted to better understand the experiences of children with asthma as they access an urban healthcare system. DESIGN AND METHODS. This descriptive study used a convenience sample of 34 families of pediatric asthma patients who participated in semistructured interviews and closed medical record review. RESULTS. Only one patient reported having a written exacerbation management plan. Beliefs regarding medication addiction and side effects were frequently reported as barriers to medication adherence, and children seeking asthma care in primary care settings saw many care providers. PRACTICE IMPLICATIONS. Exploring how expanded nursing roles can help address both family and system factors serving as barriers to health care ought to be a key priority for nursing. Search terms: Accessibility, asthma, health beliefs, health services