Article Explores Relationship Between Medical Home and Unmet Needs for Children with Autism Spectrum Disorders

July 17, 2013

"Parents [of children with autism spectrum disorder (ASD)] reported substantial difficulties accessing high quality primary care and adequate specialty care services," write the authors of an article published in Maternal and Child Health Journal online on June 23, 2013. Having access to care through a medical home has been associated with fewer unmet needs for specialty care, greater parental satisfaction with health care services, better health, lower costs, and decreased health disparities among children with chronic health conditions. The role of the primary care medical home is less established for individuals with ASD. The purpose of the study described in this article was to examine the relationship between standardized measures of the medical home and unmet needs for a broad range of specialty care services, after accounting for child and family characteristics that may influence access to care.

The study sample included 371 parent-child dyads recruited from the Interactive Autism Network, a national online registry for individuals with ASD and their families. Parents of children enrolled in a national autism registry were invited to complete an access-to-care questionnaire. All children included in the study were under age 18.
The analyses determined whether having a medical home was associated with the number of unmet needs for specialty care.

The authors found that
* Only 18.9 percent of children had access to a medical home with all five components of quality care (having a personal doctor or nurse, usual sources of care, no problems obtaining referrals, family-centered care, and coordinated care.).
* Nearly all parents (98.9 percent) reported that their child had at least one specialty care service need. Of these children, sixty-three percent had at least one unmet specialty care need.
* When comparing the unmet needs of those children with and without medical homes, the mean number of total unmet specialty care needs for children with medical homes was significantly lower than for those without medical homes.
* For eight types of specialty care services, children with medical homes had fewer unmet needs compared to those without medical homes in four areas: care from a specialty care doctor (10.3 percent unmet needs for those with medical homes vs. 34.7 percent for those without), behavioral therapy (35.0 percent vs. 67.9 percent), mental health services (20.0 percent vs. 45.2 percent), and communication aids or devices (0.0 percent vs. 58.9 percent).
* The final analysis showed a significant relationship between having a medical home and children's unmet needs for specialty care services, even after accounting for variance due to demographic, child, and family factors.

The authors conclude that "future research should continue to examine the relationship between the medical home and access to services for children with ASD."

Farmer JE, Clark MJ, Mayfield WA, et al. 2013. The relationship between the medical home and unmet needs for children with autism spectrum disorders. Maternal and Child Health Journal [published online on June 23, 2013]. Abstract available at

Information courtesy of MCH Alert
MCH Alert is produced by Maternal and Child Health Library at the Nation