Published online August 31, 2005
PEDIATRICS Vol. 116 No. 3 September 2005, pp. 649-656 (doi:10.1542/peds.2004-0647)
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Comprehensive Primary Care for Children With Special Health Care Needs in Rural Areas

Janet E. Farmer, PhD*, Mary J. Clark, RN, MPH*, Ashley Sherman, MA{ddagger}, Wendi E. Marien, MA§ and Thomas J. Selva, MD||

* Department of Health Psychology
{ddagger} Office of Medical Research
§ Department of Psychological Sciences
|| Department of Child Health, University of Missouri Health Sciences Center, Columbia, Missouri

Objective. Most research on comprehensive primary care interventions for children with chronic health conditions has been conducted in large urban areas, where child health and related services are readily available. The purpose of this study was to evaluate the feasibility and impact of a medical home demonstration project in a more rural part of the country.

Methods. Fifty-one parents of children with special health care needs participated in a pre-/posttreatment assessment of a program designed to enhance comprehensive and coordinated care. Participants were recruited from 3 primary care practices in a central Midwest state and remained in the program for ~12 months.

Results. Parents reported significant increases in satisfaction with care coordination and access to mental health services after the intervention. They also noted decreases in family needs, caregiver strain, parents’ missed work days, children’s school absences, and utilization of ambulatory services. Satisfaction with primary care declined slightly but remained in the "very good" range. Families of children with more complex conditions were more likely to report a decrease in needs after intervention, but other factors, such as geographic location or socioeconomic status, were not related to key outcome variables.

Conclusions. Comprehensive care has a positive effect on children with chronic health conditions and their families, including those who live in more rural areas. Additional study is needed to learn more about rural service delivery strategies that promote implementation of this approach in general practice.

Key Words: medical home • children with special health care needs • rural health services

Abbreviations: CSHCN, children with special health care needs • SES, socioeconomic status • NP, nurse practitioner

Accepted Dec 20, 2004.




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