Published online April 2, 2007
PEDIATRICS Vol. 119 No. 4 April 2007, pp. e821-e828 (doi:10.1542/peds.2006-1896)
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ARTICLE

Preventive Health Care for Children With and Without Special Health Care Needs

Amy J. Houtrow, MD, MPHa, Sue E. Kim, PhD, MPHb,c, Alex Y. Chen, MD, MSHSd and Paul W. Newacheck, DrPHa,c

a Department of Pediatrics
b Medicine
c Institute for Health Policy Studies, University of California at San Francisco, San Francisco, California
d Department of Pediatrics, Childrens Hospital Los Angeles, University of Southern California, Los Angeles, California

OBJECTIVE. The objective of this study was to compare the receipt of preventive health services for children with and without special health care needs and to identify predictors of these health services for children with special health care needs using nationally representative data.

METHODS. Data from the 2002 and 2003 Medical Expenditure Panel Surveys were analyzed. A total of 18279 children aged 3 to 17 years were included in our study. The Child Preventive Health Supplement was used to identify caregiver recall of specific health screening measures and anticipatory guidance during the previous 12 months. Odds ratios were calculated for predictive factors of preventive services for children with special health care needs.

RESULTS. The prevalence of special health care needs in children aged 3 to 17 years was 21.6%. Based on caregiver reports, 87.5% of children with special health care needs had ≥1 health screening measure checked in the past year compared with 73.1% of children without special health care needs. Receipt of ≥1 topic of anticipatory guidance was reported for 69.8% of children with special health care needs compared with 55.2% of children without special health care needs. Black and Hispanic caregivers of children with special health care needs were more likely than others to report receipt of all 6 categories of anticipatory guidance measured in this study.

CONCLUSIONS. We found that caregivers of children with special health care needs were more likely to report receipt of anticipatory guidance and health screening than were caregivers of children without special health care needs. Although a majority of these caregivers reported receiving some health screening and anticipatory guidance on an annual basis, there are clear gaps in the delivery of preventive health services. This study identifies areas for improvement in the delivery of preventive health services for children with special health care needs and children in general.

Key Words: children with special health care needs • Medical Expenditure Panel Survey • preventive care • anticipatory guidance • health screening • well-child care • pediatric health maintenance

Abbreviations: CSHCN—Children with Special Health Care Needs • AAP—American Academy of Pediatrics • MCHB—Maternal and Child Health Bureau • MEPS—Medical Expenditure Panel Survey • OR—odds ratio • CI—confidence interval • FPL—federal poverty level • AHRQ—Agency for Healthcare Research and Quality

Accepted Oct 10, 2006.


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