Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, MS 035, 415 South Street, Waltham, MA 02453, USA.
Matern Child Health J. 2012 Jul;16(5):1081-91. doi: 10.1007/s10995-011-0833-6.
To investigate the health care experiences of children with autism spectrum disorder, whether they have unmet needs, and if so, what types, and problems they encounter accessing needed care. We address these issues by identifying four core health care services and access problems related to provider and system characteristics. Using data from the 2005-2006 National Survey of Children with Special Health Care Needs (NS-CSHCN) we compared children with autism spectrum disorder with children with special health care needs with other emotional, developmental or behavioral problems (excluding autism spectrum disorder) and with other children with special health care needs. We used weighted logistic regression to examine differences in parent reports of unmet needs for the three different health condition groups. Overall unmet need for each service type among CSHCN ranged from 2.5% for routine preventive care to 15% for mental health services. After controlling for predisposing, enabling and need factors, some differences across health condition groups remained. Families of children with autism spectrum disorder were in fact significantly more at risk for having unmet specialty and therapy care needs. Additionally, families of children with autism spectrum disorder were more likely to report provider lack of skills to treat the child as a barrier in obtaining therapy and mental health services. Disparities in unmet needs for children with autism suggest that organizational features of managed care programs and provider characteristics pose barriers to accessing care.
为了调查自闭症谱系障碍儿童的医疗保健体验，了解他们是否存在未满足的需求，如果有，是什么类型的需求，以及在获得所需护理方面存在哪些问题。我们通过确定与提供者和系统特征相关的四项核心医疗保健服务和获取问题来解决这些问题。利用 2005-2006 年全国特殊健康需求儿童调查（NS-CSHCN）的数据，我们将自闭症谱系障碍儿童与有其他情绪、发育或行为问题（不包括自闭症谱系障碍）的特殊健康需求儿童以及有其他特殊健康需求的儿童进行了比较。我们使用加权逻辑回归来检查三组不同健康状况群体的父母报告的未满足需求差异。总体而言，特殊健康需求儿童中每种服务类型的未满足需求比例从常规预防保健的 2.5%到心理健康服务的 15%不等。在控制了倾向因素、使能因素和需求因素后，健康状况组之间仍存在一些差异。自闭症谱系障碍儿童的家庭实际上面临更大的风险，需要满足特殊治疗护理需求。此外，自闭症谱系障碍儿童的家庭更有可能报告提供者缺乏治疗孩子的技能，这是获得治疗和心理健康服务的障碍。自闭症儿童未满足的需求存在差异，这表明管理式医疗保健计划的组织特征和提供者特征对获得护理构成了障碍。
