California Center for Population Research

Objective. To describe the proportion, characteristics, and attitudes of pediatricians who want to allocate more time in primary care to children with special health care needs (CSHCN). Methods. Data from a national random sample mail survey of 1000 pediatricians were used to examine attitudes towards allocating more time to CSHCN, and associated preferences towards changes to primary care. Results. Sixty percent (n=502) of eligible subjects participated. Forty-five percent of pediatricians reported that, if they could redesign their practices to maximize efficiency and effectiveness, they would allocate more time to providing care to CSHCN. After multivariate adjustment, respondents who wanted to allocate more time to CSHCN were more likely to want to allocate more time to care coordination with staff (OR 3.6[1.7-7.4, p≤0.001]) and non-visit communication with parents (OR 3.0[1.7-5.5], p≤0.001), and were more likely to prefer delegation of well-child care services to non-physicians (OR 5.9[2.8-12.5], p≤0.001). Inadequate reimbursement was reported as the most important obstacle to implementing such changes in their practices. Conclusions. These findings suggest that a substantial number of pediatricians would ideally allocate more time in primary care to CSHCN. Systems of care that could support such a change should be investigated.