title: The doctor's dilemma: challenges for the primary care physician caring for the child with special health care needs.
abstract: OBJECTIVE
  To identify barriers to providing quality primary care to children with special health care needs (CSHCN).
  
  
  METHODS
  Descriptive cross-sectional needs assessment of primary care physicians caring for CSHCN. The population consists of 30 physicians from 2 health centers and 4 private offices participating in an intervention study designed to enhance primary care for CSHCN and 20 physicians from comparable sites (2 health centers, 5 private offices). An 86-item questionnaire was administered to participants.
  
  
  RESULTS
  Among these physicians who care for large numbers of CSHCN, over 70% were satisfied with specialist care, emergency room, and hospital care. By contrast, fewer than 50% reported satisfaction with mental health services, information available for families, access to case managers, and resources for transition-to-adult services. Seventy-one percent reported that compensation systems affected care, and more than half the physicians reported needing more time or staff to provide optimal care for CSHCN.
  
  
  CONCLUSIONS
  Experienced physicians providing primary care for large numbers of CSHCN report that their care is adversely affected by compensation systems. There is extensive dissatisfaction with the availability of mental health services, access to community resources, transition services, and availability of written information for families.
authors.affiliation: Children's Hospital, Department of Medicine, Division of General Pediatrics, Boston, MA 02115, USA.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Davidson
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Silva
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Sofis
authors.forename: Michael L
authors.initials: ML
authors.lastname: Ganz
authors.forename: Judith S
authors.initials: JS
authors.lastname: Palfrey
mesh_terms: D001900:Boston; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities; D006801:Humans; D020380:Needs Assessment; D010372:Pediatrics; D011787:Quality of Health Care