title: Pediatricians' Comfort Level in Caring for Children With Special Health Care Needs.
abstract: Few studies have investigated pediatrician attitudes about providing primary medical care for children with special health care needs. The objective of this study was to determine pediatrician perspectives on their comfort level in providing care and on where the medical home should be for children with chronic medical and developmental conditions.
  
  
  
  Survey of pediatricians in California in 2014. Pediatricians were randomized to receive surveys featuring either a case of a child with a chronic medical (neurofibromatosis) or a developmental condition (autism). They were then asked about their comfort level in providing primary care for the child. We developed logistic regression models to adjust for practice and provider factors, and availability of family social resources.
  
  
  
  The survey response rate was 50.2%. Primary care pediatricians expressed more comfort than nonprimary care pediatricians in providing a medical home for a child with chronic medical or developmental condition (range, 84%-92% comfortable vs 58%-79% comfortable), respectively. All pediatricians expressed more comfort providing care for a child with autism than neurofibromatosis. Nearly all primary care pediatricians (90%) believed that the medical home should be in pediatric primary care practice. Pediatrician comfort in becoming a medical home was higher when the family had more social resources.
  
  
  
  Most pediatricians endorse that the medical home for children with special health care needs be in the primary care setting. Improving access to subspecialty care and providing resources, such as case management, to address family social complexity might raise pediatrician comfort in providing primary care to children with medical and developmental conditions.
authors.affiliation: Division of General Pediatrics, University of California, San Francisco; Division of General Internal Medicine, University of California, San Francisco; Phillip R. Lee Institute for Health Policy Studies, University of California, San Francisco. Electronic address: megumi.okumura@ucsf.edu.
authors.forename: Megumi J
authors.initials: MJ
authors.lastname: Okumura
authors.affiliation: Division of General Pediatrics, University of California, San Francisco; School of Public Health, University of California, Berkeley.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Knauer
authors.affiliation: American Academy of Pediatrics, California Foundation, American Academy of Pediatrics, California, Sacramento.
authors.forename: Kris E
authors.initials: KE
authors.lastname: Calvin
authors.affiliation: Division of General Pediatrics, University of California, San Francisco.
authors.forename: John I
authors.initials: JI
authors.lastname: Takayama
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002140:California; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000379:methods; D000072143:Pediatricians / Q000523:psychology*; D011320:Primary Health Care; D011795:Surveys and Questionnaires
keywords: children with special health care needs; medical home; pediatrician; pediatrician comfort