title: Does connection to primary care matter for children with attention-deficit/hyperactivity disorder?
abstract: 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.
authors.affiliation: Harvard-wide Pediatric Health Services Research Fellowship, Boston, Massachusetts, USA. sara.toomey@childrens.harvard.edu
authors.forename: Sara L
authors.initials: SL
authors.lastname: Toomey
authors.forename: Jonathan
authors.initials: J
authors.lastname: Finkelstein
authors.forename: Karen
authors.initials: K
authors.lastname: Kuhlthau
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000628:therapy*; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D020380:Needs Assessment; D016017:Odds Ratio; D011320:Primary Health Care / Q000592:standards* / Q000639:trends; D011336:Probability; D011787:Quality of Health Care; D018570:Risk Assessment; D012720:Severity of Illness Index; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States