CSHCN in Texas: meeting the need for specialist care.
OBJECTIVE
Assuring the sufficiency and suitability of systems of care and services for children with special health care needs (CSHCN) presents a challenge to Texas providers, agencies, and state Title V programs. To meet the need for specialist care, referrals from primary care doctors are often necessary. The objective of this study was to describe the factors associated with the need for specialist care and problems associated with obtaining referrals in Texas.


METHODS
Bivariate and multivariate analyses were performed using the National Survey of Children with Special Health Care Needs (NS-CSHCN) weighted sample for Texas (n = 719,014) to identify variables associated with the need for specialist care and problems obtaining referrals for specialist care.


RESULTS
Medical need of the CSHCN and sensitivity to family values/customs was associated with greater need for specialist care, and Hispanic ethnicity and lower maternal education were associated with less need. Medical need, amount of time spent with doctors and sensitivity to values/customs, living in a large metropolitan statistical area, and lack of medical information were associated with problems obtaining a specialist care referral.


CONCLUSIONS
Findings revealed some similarities and differences with meeting the need for specialist care when comparing Texas results to other studies. In Texas, aspects of customer satisfaction variables, especially doctors' sensitivity to family values/customs and parents' not receiving enough information on medical problems, were significantly associated with problems obtaining specialist referrals. Findings indicate a need to further research relationships and communication among doctors, CSHCN, and their families.
Young
M Cherilyn
MC
Research & Public Health Assessment Office, Division of Family & Community Health Services, Texas Department of State Health Services, 1100 West 49th Street, Austin, Texas 78756, USA.
Drayton
Vonna L C
VL
Menon
Ramdas
R
Walker
Lesa R
LR
Parker
Colleen M
CM
Cooper
Sam B
SB
Bultman
Linda L
LL
D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D003625:Data Collection; D019988:Children with Disabilities; D006301:Health Services Needs and Demand; D006801:Humans; D008511:Medicine; D012017:Referral and Consultation; D012923:Social Class; D013038:Specialization; D013781:Texas