Medical Home for Children with Special Health Care Needs in North Carolina

Background: A medical home is a model of care defined by the American Academy ofPediatrics as medical care for children that is accessible, continuous, comprehensive, family-centered, coordinated and compassionate. North Carolina uses the medical home concept as a model for providing high quality care to children with special health care needs (CSHCN). However, information on characteristics ofCSHCN, predictors of having a medical home and the impact of having a medical home on outcomes ofCSHCN in North Carolina are not available. Methods: This study uses the data from the National Survey of Children with Special Health Care Needs conducted between 2000 and 2002. A random sample of parents or caregivers of CSHCN was surveyed in the United States. Information on health status ofCSHCN, health care experiences and insurance status was obtained. This study is limited to the data obtained from North Carolina. The characteristics of children with special health care needs are described. Bivariate analysis of socio-demographic factors with medical home and its 5 components (family-centered care, effective care coordination, personal doctor or nurse, usual source, referral problems) was carried out. Multivariate analysis was conducted to identif'y the predictors of having a medical home. The impact of having a medical home on the outcomes ofCSHCN and their families was assessed. Results: Fifty six percent ofCSHCN in North Carolina have a medical home. Race/ethnicity and severity of impairment ofCSHCN are independent predictors of having a medical home in this population. White CSHCN have 1. 7 times the odds of not having a medical home compared to non-White CSHCN and those with no limitation of activities due to their condition have 1.6 times the odds of having a medical home compared to those who have limitation of activities. Children who have a medical home are less likely to have unmet health services needs or to have delayed or foregone care, and respondents were more likely to report that the health services were easy to use and to be satisfied with the serv1ces. Conclusions: This study provides comprehensive information about CSHCN in North Carolina which can be used for needs assessment, and implementation and evaluation of programs for CSHCN in North Carolina. Disparities among CSHCN due to race/ethnicity and severity of their condition should be considered in organizing services for CSHCN in North Carolina. Future studies are needed to evaluate the 5 components of medical home and their impact on child health outcomes.Master of Public Healt

How do parents of children with juvenile idiopathic arthritis (JIA) perceive their therapies?

<p>Abstract</p> <p>Background</p> <p>Complementary and alternative medical (CAM) therapies are commonly used by pediatric patients with chronic medical conditions. Little is known about parents' perceptions of these therapies. This study describes the views of parents of patients with juvenile idiopathic arthritis (JIA) regarding conventional and CAM therapies.</p> <p>Methods</p> <p>Parents of children with JIA seen at a pediatric rheumatology clinic were surveyed between June 1 and July 31, 2007. Questionnaires asked about patients' use of over 75 therapies in the past 30 days, their perceived helpfulness (0 = not helpful; 3 = very helpful), perceived side effects (0 = none; 3 = severe), and whether each therapy would be recommended to other patients with JIA (Yes, No, Not sure).</p> <p>Results</p> <p>Questionnaires were returned by 52/76 (68%) parents; patients' average age was 10.9 years and 87% were Caucasian. Medications were used by 45 (88%) patients; heat (67%) and extra rest (54%) were also commonly used. CAM therapies were used by 48 (92%), e.g., massage (54%), vitamins and other supplements (54%), avoiding foods that worsened pain (35%) and stress management techniques (33%). Among the therapies rated by 3 or more parents, those that scored 2.5 or higher on helpfulness were: biologic medications, methotrexate, naproxen, wheelchairs, orthotics, heat, vitamins C and D, music, support groups and prayer. CAM therapies had 0 median side effects and parents would recommend many of them to other families.</p> <p>Conclusion</p> <p>JIA patients use diverse therapies. Parents report that many CAM therapies are helpful and would recommend them to other parents. These data can be used in counseling patients and guiding future research.</p