Division of General Pediatrics, University of California, 3333 California Street, STE 245, San Francisco, CA, 94118, USA.
Division of General Internal Medicine, University of California, San Francisco, CA, USA.
Matern Child Health J. 2018 Jul;22(7):1042-1050. doi: 10.1007/s10995-018-2484-3.
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.
儿科医生在为有特殊医疗需求的儿童（CSHCN）提供护理方面面临着诸多挑战。很少有研究描述过支持儿科医生照顾 CSHCN 的可用医疗资源。本研究调查了用于照顾 CSHCN 的现有资源，以及与实践中 CSHCN 比例较高相关的因素。
我们对加利福尼亚州美国儿科学会的在职成员进行了全州范围的调查，以研究儿科亚专科医疗服务的可及性、社区和办公室资源以及实践障碍。我们对实践中“高于平均比例”的 CSHCN 进行了逻辑回归模型分析，调整了人口统计学因素、实践类型（农村与郊区/城市）和医疗资源、护理满意度以及亚专科医疗服务的可及性。
我们的回复率为 50.2%（n=1290）；75%的受访者报告提供了一些初级保健服务，许多初级保健儿科医生照顾了很大比例的 CSHCN。儿科医生报告他们的实践中有平均 28%的 CSHCN。农村儿科医生缺乏亚专科医疗服务（10-59%的医生报告无法获得各种亚专科的服务）。与实践中 CSHCN 比例较高相关的因素包括在学术医疗中心工作以及对照顾 CSHCN 的满意度。
儿科医生报告说他们缺乏获得心理健康服务、护理协调和病例管理的途径。学术医疗中心和医生对 CSHCN 护理的满意度较高与实践中 CSHCN 比例较高有关。促进支持儿科医生的方法，例如与行为专家合作，可能对于鼓励初级保健儿科医生为 CSHCN 提供医疗服务至关重要。
