title: Enhanced Access and Parents' Preferred Contact for a Child's Chronic Condition.
abstract: To assess whether the perception of enhanced access by parents in their child's primary care and main specialty practices is associated with preference for contacting either practice when problems arise with a child's chronic condition.
  
  
  
  In this cross-sectional survey study of parents whose children use both primary and specialty practices, we assessed perceptions of 3 components of enhanced access: (1) appointment availability when needed, (2) electronic communication with practices, and (3) other staff that help manage a child's health care needs. Parents also indicated which practice they would contact for an exacerbation of the main chronic condition for which the child receives specialty care. We used logistic regression to examine relationships of enhanced access components in both practices with parents' indicated practice.
  
  
  
  Among 609 parents, 244 (40%) would contact primary care and 365 (60%) the main specialty practice for a chronic condition exacerbation. Although parents perceived enhanced access components with similar frequency in both settings, enhanced access was associated only with preference for contacting the main specialty practice: e-mail communication (aOR for preferring the specialty practice 2.0 [1.3, 3.2]) and staff that coordinate a child's care needs (aOR 2.8 [1.4, 5.9]).
  
  
  
  Enhanced access is associated with preference for addressing chronic condition exacerbations in specialty but not primary care. Future study should further identify factors important to parents in deciding when and how to contact practices and should seek to develop family-centered communication within medical homes that integrate primary and specialty care.
authors.affiliation: Division of General Pediatrics and Adolescent Medicine, UNC School of Medicine, Chapel Hill, NC. Electronic address: dejong@med.unc.edu.
authors.forename: Neal A
authors.initials: NA
authors.lastname: deJong
authors.affiliation: Division of Pediatric Pulmonology, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: Elisabeth P
authors.initials: EP
authors.lastname: Dellon
authors.affiliation: Division of General Pediatrics and Adolescent Medicine, UNC School of Medicine, Chapel Hill, NC.
authors.forename: Emily B
authors.initials: EB
authors.lastname: Vander Schaaf
authors.affiliation: University of North Carolina Health Care System, Chapel Hill, NC.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Stiles
authors.affiliation: University of North Carolina Health Care System, Chapel Hill, NC.
authors.forename: Rachael A
authors.initials: RA
authors.lastname: Carr
authors.affiliation: Division of General Pediatrics and Adolescent Medicine, UNC School of Medicine, Chapel Hill, NC.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Steiner
mesh_terms: D001294:Attitude to Health; D002648:Child; D002908:Chronic Disease / Q000628:therapy; D003430:Cross-Sectional Studies; D006297:Health Services Accessibility; D006801:Humans; D008511:Medicine; D010290:Parents / Q000523:psychology*; D057240:Patient Preference; D011320:Primary Health Care; D057566:Self Report
keywords: children with chronic conditions; enhanced access; parent-provider communication; parental preferences