title: Montana primary care providers' access to and satisfaction with pediatric specialists when caring for children with special health care needs.
abstract: OBJECTIVE
  Primary care providers (PCPs) of children with special health care needs (CSHCN) in rural areas face challenges in accessing specialty care to support a patient-centered medical home. This study assessed the practice characteristics and attitudes regarding pediatric specialty care among Montana PCPs of CSHCN.
  
  
  METHODS
  We surveyed 433 Montana PCPs identified through a statewide registry. Demographic and practice information was collected, including the proportion of time spent on CSHCN care coordination. A 5-point Likert scale was used to calculate mean need scores for each pediatric specialty, access to these specialties, and barriers to care. Results were analyzed separately for pediatricians and family physicians, as well as rural and urban providers, using λ2, t tests, and Mann-Whitney tests.
  
  
  RESULTS
  Of the PCPs surveyed, 386 had a valid address and were currently practicing in Montana, 112 (29%) responded, and 91 provided care to CSHCN (averaged 29% of time spent in CSHCN care coordination). Child psychiatry (4.1) and developmental/behavioral pediatrics (3.7) were identified as the most needed specialties, yet they scored lowest in access to care (2.2 and 2.6, respectively). The most important rated specialist characteristics were quality (4.1), availability (3.5), and communication skills (2.8). Among the top barriers to care, lack of appropriate specialists was identified by 82% of PCPs.
  
  
  CONCLUSIONS
  Specialty care delivery for CSHCN in rural areas such as Montana should focus on matching availability with the identified need for specialty services, and ensuring that systems of communication between PCPs and specialists support the care coordination function of PCPs.
authors.affiliation: Program in Public Health, Brown University, Providence, RI, USA. rose.hardy@cchmc.org
authors.forename: Rose
authors.initials: R
authors.lastname: Hardy
authors.forename: Patrick
authors.initials: P
authors.lastname: Vivier
authors.forename: Frederick
authors.initials: F
authors.lastname: Rivara
authors.forename: Sandford
authors.initials: S
authors.lastname: Melzer
mesh_terms: D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D003142:Communication; D003258:Consumer Behavior; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D009009:Montana; D011320:Primary Health Care / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013038:Specialization