Davidson Emily J, Silva Thomas J, Sofis Lisa A, Ganz Michael L, Palfrey Judith S
Children's Hospital, Department of Medicine, Division of General Pediatrics, Boston, MA 02115, USA.
Ambul Pediatr. 2002 May-Jun;2(3):218-23. doi: 10.1367/1539-4409(2002)002<0218:tdsdcf>2.0.co;2.
To identify barriers to providing quality primary care to children with special health care needs (CSHCN).
Descriptive cross-sectional needs assessment of primary care physicians caring for CSHCN. The population consists of 30 physicians from 2 health centers and 4 private offices participating in an intervention study designed to enhance primary care for CSHCN and 20 physicians from comparable sites (2 health centers, 5 private offices). An 86-item questionnaire was administered to participants.
Among these physicians who care for large numbers of CSHCN, over 70% were satisfied with specialist care, emergency room, and hospital care. By contrast, fewer than 50% reported satisfaction with mental health services, information available for families, access to case managers, and resources for transition-to-adult services. Seventy-one percent reported that compensation systems affected care, and more than half the physicians reported needing more time or staff to provide optimal care for CSHCN.
Experienced physicians providing primary care for large numbers of CSHCN report that their care is adversely affected by compensation systems. There is extensive dissatisfaction with the availability of mental health services, access to community resources, transition services, and availability of written information for families.
确定为有特殊医疗需求的儿童（CSHCN）提供优质初级保健的障碍。
对为CSHCN提供护理的初级保健医生进行描述性横断面需求评估。研究人群包括来自2个健康中心和4个私人诊所的30名医生，他们参与了一项旨在加强对CSHCN初级保健的干预研究，以及来自可比地点（2个健康中心、5个私人诊所）的20名医生。向参与者发放了一份包含86个条目的问卷。
在这些照顾大量CSHCN的医生中，超过70%对专科护理、急诊室和医院护理感到满意。相比之下，报告对心理健康服务、家庭可用信息、获得个案管理员的机会以及向成人服务过渡的资源感到满意的医生不到50%。71%的医生报告称薪酬体系影响了护理，超过一半的医生报告需要更多时间或工作人员来为CSHCN提供最佳护理。
为大量CSHCN提供初级保健的经验丰富的医生报告称，他们的护理受到薪酬体系的不利影响。对心理健康服务的可及性、社区资源的获取、过渡服务以及为家庭提供书面信息的情况存在广泛不满。
