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Preventive health care for children with and without special health care needs
Amy J Houtrow1, Sue E Kim, Alex Y Chen
1Department of Pediatrics, University of California at San Francisco, San Francisco, California, USA. houtrowa@peds.ucsf.edu
Insights
Children with special health care needs receive more preventive services, yet gaps remain. This study highlights areas for improving health screenings and guidance for all children.
Area of Science:
- Pediatric Health Services
- Preventive Care
- Child Health Disparities
Background:
- Children with special health care needs (CSHCN) often require tailored health services.
- Understanding receipt of preventive care is crucial for CSHCN outcomes.
- Nationally representative data can illuminate disparities in child preventive health.
Purpose of the Study:
- To compare preventive health service delivery for CSHCN versus those without.
- To identify predictors of preventive service utilization among CSHCN.
- To inform improvements in preventive care for all children.
Main Methods:
- Analysis of 2002-2003 Medical Expenditure Panel Surveys (MEPS).
- Inclusion of 18,279 children aged 3-17 years.
- Utilized Child Preventive Health Supplement for caregiver-reported screening and guidance.
Main Results:
- Prevalence of CSHCN was 21.6%.
- CSHCN caregivers reported higher rates of health screening (87.5% vs 73.1%) and anticipatory guidance (69.8% vs 55.2%).
- Black and Hispanic caregivers of CSHCN reported higher receipt of all guidance categories.
Conclusions:
- Caregivers of CSHCN reported greater receipt of preventive services.
- Despite higher utilization, significant gaps exist in preventive care delivery for CSHCN.
- Findings identify key areas for enhancing preventive health services for CSHCN and the general child population.
Objective:
The objective of this study was to compare the receipt of preventive health services for children with and without special health care needs and to identify predictors of these health services for children with special health care needs using nationally representative data.
Methods:
Data from the 2002 and 2003 Medical Expenditure Panel Surveys were analyzed. A total of 18,279 children aged 3 to 17 years were included in our study. The Child Preventive Health Supplement was used to identify caregiver recall of specific health screening measures and anticipatory guidance during the previous 12 months. Odds ratios were calculated for predictive factors of preventive services for children with special health care needs.
Results:
The prevalence of special health care needs in children aged 3 to 17 years was 21.6%. Based on caregiver reports, 87.5% of children with special health care needs had > or = 1 health screening measure checked in the past year compared with 73.1% of children without special health care needs. Receipt of > or = 1 topic of anticipatory guidance was reported for 69.8% of children with special health care needs compared with 55.2% of children without special health care needs. Black and Hispanic caregivers of children with special health care needs were more likely than others to report receipt of all 6 categories of anticipatory guidance measured in this study.
Conclusions:
We found that caregivers of children with special health care needs were more likely to report receipt of anticipatory guidance and health screening than were caregivers of children without special health care needs. Although a majority of these caregivers reported receiving some health screening and anticipatory guidance on an annual basis, there are clear gaps in the delivery of preventive health services. This study identifies areas for improvement in the delivery of preventive health services for children with special health care needs and children in general.
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