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Pediatricians' Comfort Level in Caring for Children With Special Health Care Needs

Published:February 25, 2017DOI:https://doi.org/10.1016/j.acap.2017.02.009

      Abstract

      Background

      Few studies have investigated pediatrician attitudes about providing primary medical care for children with special health care needs. The objective of this study was to determine pediatrician perspectives on their comfort level in providing care and on where the medical home should be for children with chronic medical and developmental conditions.

      Methods

      Survey of pediatricians in California in 2014. Pediatricians were randomized to receive surveys featuring either a case of a child with a chronic medical (neurofibromatosis) or a developmental condition (autism). They were then asked about their comfort level in providing primary care for the child. We developed logistic regression models to adjust for practice and provider factors, and availability of family social resources.

      Results

      The survey response rate was 50.2%. Primary care pediatricians expressed more comfort than nonprimary care pediatricians in providing a medical home for a child with chronic medical or developmental condition (range, 84%–92% comfortable vs 58%–79% comfortable), respectively. All pediatricians expressed more comfort providing care for a child with autism than neurofibromatosis. Nearly all primary care pediatricians (90%) believed that the medical home should be in pediatric primary care practice. Pediatrician comfort in becoming a medical home was higher when the family had more social resources.

      Conclusions

      Most pediatricians endorse that the medical home for children with special health care needs be in the primary care setting. Improving access to subspecialty care and providing resources, such as case management, to address family social complexity might raise pediatrician comfort in providing primary care to children with medical and developmental conditions.

      Keywords

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      References

        • American Academy of Pediatrics Medical Home Initiatives for Children With Special Needs Project Advisory Committee
        Policy statement: organizational principles to guide and define the child health care system and/or improve the health of all children.
        Pediatrics. 2004; 113: 1545-1547
        • Cooley W.C.
        • McAllister J.W.
        Building medical homes: improvement strategies in primary care for children with special health care needs.
        Pediatrics. 2004; 113: 1499-1506
      1. Measuring medical home for children and youth. Methods and findings from the National Survey of Children with Special Health Care Needs and the National Survey of Children's Health. Available at: http://www.childhealthdata.org/docs/medical-home/mhmanual_withappendices-updated-12-7-10-pdf. Accessed April 8, 2016.

        • Porterfield S.L.
        • DeRigne L.
        Medical home and out-of-pocket medical costs for children with special health care needs.
        Pediatrics. 2011; 128: 892-900
      2. American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), American Osteopathic Association (AOA). Joint principles of the patient-centered medical home. March 2007. Available at: http://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf. Accessed March 18, 2016.

      3. Fleming C. Health Policy Brief: Patient-Centered Medical Homes. Vol 2016: Health Affairs; September 15, 2010. Available at: http://healthaffairs.org/blog/2010/09/15/health-policy-brief-patient-centered-medical-homes/. Accessed April 8, 2016.

      4. Data Resource Center for Child & Adolescent Health. California. Medical Home Performance Profile for Children With Special Health Care Needs (CSHCN). Data Source: 2009/10 National Survey of Children with Special Health Care Needs (NS-CSHCN). Available at: http://www.childhealthdata.org/docs/medical-home/2009-10-mhreports_ca-705.pdf?sfvrsn=2. Accessed April 8, 2016.

        • Gupta V.B.
        • O'Connor K.G.
        • Quezada-Gomez C.
        Care coordination services in pediatric practices.
        Pediatrics. 2004; 113: 1517-1521
        • Agrawal R.
        • Shah P.
        • Zebracki K.
        • et al.
        Barriers to care for children and youth with special health care needs: perceptions of Illinois pediatricians.
        Clin Pediatr (Phila). 2012; 51: 39-45
        • Agrawal R.
        • Shah P.
        • Zebracki K.
        • et al.
        The capacity of primary care pediatricians to care for children with special health care needs.
        Clin Pediatr (Phila). 2013; 52: 310-314
        • American Academy of Pediatrics
        Periodic Survey of Fellows #79.
        American Academy of Pediatrics, Elk Grove Village, IL2012
        • Okumura M.J.
        • Heisler M.
        • Davis M.M.
        • et al.
        Comfort of general internists and general pediatricians in providing care for young adults with chronic illnesses of childhood.
        J Gen Intern Med. 2008; 23: 1621-1627
        • Okumura M.J.
        • Kerr E.A.
        • Cabana M.D.
        • et al.
        Physician views on barriers to primary care for young adults with childhood-onset chronic disease.
        Pediatrics. 2010; 125: e748-e754
        • McPherson M.
        • Arango P.
        • Fox H.
        • et al.
        A new definition of children with special health care needs.
        Pediatrics. 1998; 102: 137-140
        • Institute of Medicine (U.S.), Division of Health Care Services, Committee on the Future of Primary Care, Donaldson MS
        Primary Care: America's Health in a New Era.
        National Academy Press, Washington, DC1996
        • Medical Home Initiatives for Children With Special Needs Project Advisory Committee, American Academy of Pediatrics
        The medical home.
        Pediatrics. 2002; 110: 184-186
        • Kuo D.Z.
        • Cohen E.
        • Agrawal R.
        • et al.
        A national profile of caregiver challenges among more medically complex children with special health care needs.
        Arch Pediatr Adolesc Med. 2011; 165: 1020-1026
        • McClain M.R.
        • Cooley W.C.
        • Keirns T.
        • et al.
        A survey of the preferences of primary care physicians regarding the comanagement with specialists of children with rare or complex conditions.
        Clin Pediatr (Phila). 2014; 53: 566-570
        • Van Cleave J.
        • Okumura M.J.
        • Swigonski N.
        • et al.
        Medical homes for children with special health care needs: primary care or subspecialty service?.
        Acad Pediatr. 2016; 1: 366-372
        • Blais D.
        Nurse navigation: supporting patients and their families through the health-care system.
        Alta RN. 2008; 64: 19
        • Farmer J.E.
        • Clark M.J.
        • Drewel E.H.
        • et al.
        Consultative care coordination through the medical home for CSHCN: a randomized controlled trial.
        Matern Child Health J. 2011; 15: 1110-1118
        • Miller J.E.
        • Nugent C.N.
        • Gaboda D.
        • et al.
        Reasons for unmet need for child and family health services among children with special health care needs with and without medical homes.
        PLoS One. 2013; 8: e82570
        • Okumura M.J.
        • Saunders M.
        • Rehm R.S.
        The role of health advocacy in transitions from pediatric to adult care for children with special health care needs: bridging families, provider and community services.
        J Pediatr Nurs. 2015; 30: 714-723
        • Lobach D.F.
        • Kawamoto K.
        • Anstrom K.J.
        • et al.
        A randomized trial of population-based clinical decision support to manage health and resource use for Medicaid beneficiaries.
        J Med Syst. 2013; 37: 9922