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Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. 368-374 (doi:10.1542/peds.2007-2794)
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ARTICLE

Does Connection to Primary Care Matter for Children With Attention-Deficit/Hyperactivity Disorder?

Sara L. Toomey, MD, MPhil, MSca,b, Jonathan Finkelstein, MD, MPHb, Karen Kuhlthau, PhDc

a Harvard-wide Pediatric Health Services Research Fellowship, Boston, Massachusetts
b Department of Ambulatory Care and Prevention and Harvard Medical School, Boston, Massachusetts
c Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, Massachusetts

OBJECTIVE. Whether high-quality primary care in the form of a medical home effectively meets the health care needs of children with attention-deficit/hyperactivity disorder is unknown. The objectives of this study were to (1) describe the percentage who report unmet health care need, (2) evaluate whether having a medical home is associated with lower risk for having unmet needs, and (3) compare the impact of having a medical home on unmet need for children with attention-deficit/hyperactivity disorder with those with asthma.

METHODS. Cross-sectional analysis was conducted of the National Survey of Children's Health, 2003, a nationally representative sample. The primary outcome variable was parent-reported unmet health care need. Multivariate logistic regression tested the impact of having a medical home on unmet needs for children with attention-deficit/hyperactivity disorder and asthma.

RESULTS. The National Survey of Children's Health interviewed parents of 6030 children who had attention-deficit/hyperactivity disorder and 6133 children who had asthma and were between the ages of 6 and 17 years. A total of 16.8% of children with attention-deficit/hyperactivity disorder had at least 1 unmet need compared with 6.7% of children with asthma. Although the proportion of children with a medical home was comparable, children with attention-deficit/hyperactivity disorder were 3.5 times more likely to have an unmet need than were children with asthma. Children with asthma who have a medical home have less than half the likelihood of reporting an unmet need in comparison with those without a medical home; however, among children with attention-deficit/hyperactivity disorder, having a medical home was not associated with decreased likelihood of reporting an unmet need.

CONCLUSIONS. Having a medical home is not associated with fewer unmet needs for children with attention-deficit/hyperactivity disorder. Our results suggest that high-quality primary care may not be as successful at meeting the needs of children with behavioral health conditions compared with those with physical conditions.

Key Words: ADHD • unmet needs • primary care • medical home

Abbreviations: ADHD—attention-deficit/hyperactivity disorder • CSHCN—children with special health care needs • PCP—primary care provider • AAP—American Academy of Pediatrics • NSCH—National Survey of Children's Health, 2003 • OR—odds ratio • CI—confidence interval

Accepted Nov 15, 2007.


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