| Autor: |
Okumura MJ; Division of General Pediatrics, University of California, 3333 California Street, STE 245, San Francisco, CA, 94118, USA. megumi.okumura@ucsf.edu.; Division of General Internal Medicine, University of California, San Francisco, CA, USA. megumi.okumura@ucsf.edu.; Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, 94118, USA. megumi.okumura@ucsf.edu., Knauer HA; Division of General Pediatrics, University of California, 3333 California Street, STE 245, San Francisco, CA, 94118, USA.; School of Public Health, University of California, 50 University Hall #7360, Berkeley, CA, 94720-7360, USA., Calvin KE; American Academy of Pediatrics, California Foundation, American Academy of Pediatrics, 921 11th Street Suite 1100, Sacramento, CA, 95814, USA., Takayama JI; Division of General Pediatrics, University of California, 3333 California Street, STE 245, San Francisco, CA, 94118, USA. |
| Abstrakt: |
Background and Objectives Pediatricians face numerous challenges in providing care for children with special health care needs (CSHCN). Few studies have described health care resources available to support pediatricians to care for CSHCN. This study investigated available resources to care for CSHCN and factors associated with having a greater proportion of CSHCN in practice. Methods We conducted a statewide survey of active members of the American Academy of Pediatrics in California to study pediatric subspecialty care access, community and office resources and practice barriers. We performed a logistic regression model on having an "above average proportion" of CSHCN in practice, adjusting for demographics, practice type (rural vs. suburban/urban) and medical resources, care satisfaction, and ease of subspecialty access. Results Our response rate was 50.2% (n = 1290); 75% of respondents reported providing some primary care services, with many primary care pediatricians caring for a high proportion of CSHCN. Pediatricians reported an average of 28% CSHCN in their practices. Rural pediatricians lacked subspecialty access (10-59% reporting no access to the various subspecialties). Factors relating to higher CSHCN in practice included being in academic medical centers and satisfaction in caring for CSHCN. Conclusions Pediatricians report lack of access to mental health services, care coordination and case management. Academic medical centers and higher physician satisfaction in care delivery for CSHCN are associated with more CSHCN in practice. Promoting ways to support pediatricians, such as practice collaboration with behavioral specialists, may be necessary to encourage primary care pediatricians to provide medical homes for CSHCN. |
