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Patient-Centered Medical Home and Family Burden in Attention-Deficit Hyperactivity Disorder
Sarah D Ronis1, Constance D Baldwin, Aaron Blumkin
1*Division of General Pediatrics and Adolescent Medicine, Rainbow Babies and Children's Hospital, Department of Pediatrics, Case Western Reserve University, Cleveland, OH; †Division of General Pediatrics, Department of Pediatrics, University of Rochester, Rochester, NY; ‡Child and Adolescent Health Policy, Massachusetts General Hospital, Boston, MA; §Division of General Pediatrics, Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA.
Insights
Caring for a child with Attention-Deficit/Hyperactivity Disorder (ADHD) significantly burdens families economically. A patient-centered medical home (PCMH) can reduce these financial and employment challenges for families managing ADHD.
Area of Science:
- Pediatric Health Economics
- Family Medicine
- Child Psychology
Background:
- Attention-Deficit/Hyperactivity Disorder (ADHD) impacts child development and functioning.
- The economic consequences for families raising children with ADHD are not fully understood.
- Patient-Centered Medical Homes (PCMH) aim to improve care coordination and family support.
Purpose of the Study:
- To assess the economic burden on US families with children diagnosed with ADHD.
- To determine if access to a PCMH can mitigate this economic burden.
Main Methods:
- Cross-sectional analysis of national survey data (2005-2006, 2009-2010).
- Defined economic burden by family financial and employment problems related to the child's health.
- Used relative risk models to examine the association between PCMH and economic burden, controlling for covariates.
Main Results:
- In 2009, 26% of families faced financial problems and 36% faced employment issues due to a child's ADHD.
- Only 38% of families received care meeting PCMH criteria.
- PCMH care was linked to significantly lower relative risks of financial (RR=0.52) and employment problems (RR=0.64).
Conclusions:
- Families with children with ADHD experience substantial economic hardship.
- Family-centered care and care coordination within a PCMH show promise in reducing these burdens.
- Implementing PCMH principles can alleviate financial and employment stress for affected families.
Objective:
Attention-deficit hyperactivity disorder (ADHD) can impair child health and functioning, but its effects on the family's economic burden are not well understood. The authors assessed this burden in US families of children with ADHD, and the degree to which access to a patient-centered medical home (PCMH) might reduce this burden.
Methods:
We conducted cross-sectional analyses of 2005-2006 and 2009-2010 National Surveys of Children with Special Health Care Needs, focusing on families of children with ADHD. They defined family economic burden as (1) family financial problems (annual expenses for the child's health care or illness-related financial problems for the family) and/or (2) family employment problems (job loss, work time loss, or failure to change jobs to avoid insurance loss). Relative risk models assessed associations between PCMH and family economic burden, adjusted for child age, sex, ethnicity, ADHD severity, poverty status, caregiver education, and insurance.
Results:
In 2009, 26% of families reported financial problems because of the child's ADHD, 2.1% reported out-of-pocket expenses >5% of income, and 36% reported employment problems. Only 38% reported care that met all 5 criteria for a PCMH (similar to rates in 2005-2006). In multivariable analysis, care in a PCMH was associated with 48% lower relative risk (RR) of financial problems (RR = 0.52, p < .001) and 36% lower relative risk of employment problems (RR = 0.64, p < .001). Among PCMH components, family-centered care and care coordination were more strongly associated with lower burden.
Conclusions:
The economic burdens of families with ADHD are significant but may be alleviated by family-centered care and care coordination in a medical home.
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