Department of Health Psychology, University of Missouri, 421 Lewis Hall, Columbia, MO, 65211, USA,
Matern Child Health J. 2014 Apr;18(3):672-80. doi: 10.1007/s10995-013-1292-z.
The purpose of this study was to examine the relationship between having access to a medical home and unmet needs for specialty care services for children with autism spectrum disorders (ASD). Parents of children enrolled in a national autism registry were invited to complete an online Access to Care Questionnaire. The resulting sample consisted of 371 parents-child dyads. Bivariate and hierarchical regression analyses were conducted to determine whether having a medical home was associated with the number of unmet needs for specialty care. Less than one in five children with ASD had a medical home (18.9%). Nearly all parents reported that their child had a personal doctor or nurse as well as a usual source of care, but less than one-third received coordinated care (29.9%) and less than one-half received family-centered care (47.1%). Many children had unmet needs (63%), and the highest unmet need was for behavioral therapy. Having a medical home was associated with fewer unmet specialty care needs, even after demographic, child and family characteristics were taken into account. Children with ASD who have a medical home are more likely to have adequate access to needed services. Unfortunately, relatively few children have a medical home that includes family-centered and coordinated care. Enhancements in the delivery of primary care for children with ASD may make a real difference in access to needed specialty care services, potentially improving child and family outcomes.
本研究旨在探讨儿童自闭症谱系障碍（ASD）患者获得医疗之家与专科护理服务未满足需求之间的关系。邀请参加国家自闭症登记处的儿童父母完成在线“就诊机会问卷”。由此产生的样本包括 371 对父母-子女二人组。进行了双变量和分层回归分析，以确定是否拥有医疗之家与专科护理的未满足需求数量有关。不到五分之一的 ASD 儿童拥有医疗之家（18.9%）。几乎所有的父母都报告说他们的孩子有私人医生或护士以及常规医疗来源，但不到三分之一的儿童接受了协调护理（29.9%），不到一半的儿童接受了以家庭为中心的护理（47.1%）。许多儿童存在未满足的需求（63%），而最高的未满足需求是行为疗法。即使考虑了人口统计学、儿童和家庭特征，拥有医疗之家与较少的专科护理未满足需求相关。拥有医疗之家的 ASD 儿童更有可能获得所需服务。不幸的是，只有相对较少的儿童拥有以家庭为中心且协调的医疗之家。改善儿童自闭症的初级保健服务的提供可能会对获得所需的专科护理服务产生真正的影响，从而潜在地改善儿童和家庭的结果。
