INTRODUCTION: Persons living in rural areas tend to have poorer health than do those who live in urban areas. These disparities have been attributed, in part, to lack of access to care. As a proxy measure of access to care, researchers examined the rate of office visits after emergency department (ED) treatment for asthma between rural and urban areas and pediatric and adult patients in Hawaii. METHODS: A retrospective review of five-years of insurance claims data was performed on 7064 ED visits for asthma. Demographic information and location and type of visit were analyzed by using logistic regression and survival analysis to examine rural/urban differences. RESULTS: Patients who had an office visit after their initial ED visit were 10% less likely to have a repeat ED visit within the month. Rural residents were significantly less likely to have both follow-up office and ED visits than were their urban counterparts when adjusted for age, sex, and morbidity. When adult patient statistics were compared with pediatric patient statistics, only the adult patients demonstrated a significant difference in time to followup between rural and urban patients. CONCLUSION: Study results confirm that followup office visits are associated with a decrease in emergency visit rates and that adult rural residents are less likely to receive follow-up care than are their urban counterparts for a diagnosis of asthma. However, no significant differences were seen between followup for rural and urban children, which implies that access barriers are overcome for this group of rural residents. Further research should address the aspects of access that pertain to adults in rural areas.