Factors associated with a medical home among children with Attention-Deficit Hyperactivity Disorder
Caprice A Knapp1, Melanie Hinojosa, Jacqueline Baron-Lee
1Department of Health Outcomes and Policy, University of Florida, 1329 SW 16th Street, Room 5130, Gainesville, FL 32610, USA. cak@ichp.ufl.edu
Insights
Children with Attention-Deficit Hyperactivity Disorder (ADHD) and comorbidities are less likely to have a medical home. Having a medical home improves some health outcomes but may hinder mental health care access for these children.
Area of Science:
- Pediatric Health
- Healthcare Access
- Child Psychology
Background:
- Providing a medical home for children with Attention-Deficit Hyperactivity Disorder (ADHD) presents unique challenges.
- Limited understanding exists regarding factors influencing medical home access for children with ADHD and the impact of comorbidities.
- Comorbidities in children with ADHD can complicate care and affect their access to a consistent medical home.
Purpose of the Study:
- To identify factors associated with having a medical home and its five sub-components for children with ADHD.
- To determine the effect of having a medical home on various health outcomes for children with ADHD.
- To analyze how comorbidities influence the likelihood of children with ADHD having a medical home.
Main Methods:
- Utilized data from 5,495 children with ADHD from the 2007 National Survey of Children's Health.
- Conducted descriptive and multivariate analyses to examine associations and effects.
- Compared children with ADHD alone, ADHD with physical diagnoses, and ADHD with mental diagnoses regarding medical home access.
Main Results:
- Children with ADHD and physical diagnoses had higher frequencies of medical home access compared to those with ADHD and mental diagnoses.
- Children with ADHD and physical and/or mental comorbidities were 24-63% more likely to lack a medical home than those with ADHD alone.
- Medical home access was linked to fewer unmet health needs and missed school days, but also to less access to needed mental health care.
Conclusions:
- Parental perceptions of care differ for children with ADHD, particularly concerning medical home access.
- Pediatric medical home initiatives and policies must address the complexities of ADHD care, especially when comorbidities are present.
- Practice transformation and reimbursement policies should be adapted to better support children with ADHD and their complex care needs.
Abstract:
Providing a medical home to children with Attention-Deficit Hyperactivity Disorder (ADHD) is challenging. Little is known about the factors associated with having a medical home for these children, or how comorbidities affect having a medical home. Our study aims are: (1) identify factors associated with having a medical home and five sub-components of a medical home and (2) determine the effect of medical home on several outcomes for children with ADHD. The sample included 5,495 children with ADHD from the 2007 National Survey of Children's Health. Descriptive and multivariate analyses were conducted. Children with ADHD alone and children with ADHD plus a physical diagnosis had greater frequencies of having a medical home, or meeting the five sub-components, than children with ADHD plus a mental diagnosis. Multivariate results show that children with ADHD plus a physical and/or mental comorbidity were 24-63% more likely to be without a medical home compared to children with only ADHD. Having a medical home also had a bearing on several child health outcomes. Having a medical home was significantly associated with being less likely to have an unmet health need and having fewer missed school days; but also being less likely to have received needed mental health care (P < .05). Our results suggest that there are differences in parent's perceptions of receiving care among children with ADHD. Pediatric medical home projects and policies should acknowledge that children with ADHD often have comorbidities making their care more complex. These complexities should be addressed during practice transformation and setting reimbursement policies.
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