Unmet Health Care Need in US Adolescents and Adult Health Outcomes

Hargreaves, Dougal; Elliott, Marc N.; Viner, Russell; Richmond, Tracy K.; Schuster, Mark A.

doi:10.1542/peds.2015-0237

Cited by 87 publications

(77 citation statements)

References 21 publications

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“…1,2,5,8–10 Unmet health service needs include myriad situations in which children and their families are unable to access needed health services for the child (e.g., prescription medication, therapy services) or the family (e.g., respite care, family mental healthcare). Unmet need for health services warrants attention for CSHCN—particularly children with developmental disabilities—in general and specialty care pediatric settings, as well as other service delivery settings (e.g., schools, public health agencies), because unmet need has been suggested to lead to poor adult health and functional status outcomes, 11 which CSHCN with developmental disabilities are already prone to experience. 12 Increased knowledge of which unmet health service needs are most prevalent among children with developmental disabilities may help health system administrators more effectively allocate resources toward reducing unmet need while helping clinicians and other service providers to more quickly identify and ameliorate unmet needs families of children with developmental disabilities are likely to experience.…”

Section: Introductionmentioning

confidence: 99%

Unmet Health Services Needs Among US Children with Developmental Disabilities: Associations with Family Impact and Child Functioning

Lindly

Chavez

Zuckerman

2016

J Dev Behav Pediatr

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Objectives To determine associations of unmet need for child or family health services with (1) adverse family financial and employment impacts and (2) child behavioral functioning problems among US children with autism spectrum disorder (ASD), developmental delay (DD), and/or intellectual disability (ID). Method This was a secondary analysis of parent-reported data from the 2009–10 National Survey of Children with Special Healthcare Needs linked to the 2011 Survey of Pathways to Diagnosis and Services. The study sample (n = 3,518) represented an estimated 1,803,112 US children aged 6–17 years with current ASD, DD, and/or ID (developmental disabilities). Dependent variables included adverse family financial and employment impacts, as well as child behavioral functioning problems. The independent variables of interest were unmet need for (1) child health services and (2) family health services. Multivariable logistic regression models were fit to examine associations. Results Unmet need for child and family health services, adverse family financial and employment impacts, and child behavioral functioning problems were prevalent among US children with developmental disabilities. Unmet needs were associated with an increased likelihood of adverse family employment and financial impacts. Unmet needs were associated with an increased likelihood of child behavioral functioning problems the following year; however, this association was not statistically significant. Conclusion Unmet needs are associated with adverse impacts for children with developmental disabilities and their families. Increased access to and coordination of needed health services following ASD, DD, and/or ID diagnosis may improve subsequent outcomes for children with developmental disabilities and their families.

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Section: Introductionmentioning

confidence: 99%

Unmet Health Services Needs Among US Children with Developmental Disabilities: Associations with Family Impact and Child Functioning

Lindly

Chavez

Zuckerman

2016

J Dev Behav Pediatr

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“…Access issues are one of the primary reasons adolescents do not receive adequate health care. 5,16,17 By thoughtfully and intentionally expanding the idea of what makes a medical home to partner PCPs with SBHCs, these access issues can be significantly mitigated for youth with low SES. In addition to providing data on how care quality is improved within an expanded medical home, this study can help to inform best practices for implementing these partnerships.…”

Section: Resultsmentioning

confidence: 99%

The Adolescent "Expanded Medical Home": School-Based Health Centers Partner with a Primary Care Clinic to Improve Population Health and Mitigate Social Determinants of Health

Riley

Laurie

Plegue

et al. 2016

The Journal of the American Board of Family Medicine

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Introduction: Access to high-quality health care is a crucial social determinant of health. We describe the implementation of an "expanded medical home" partnering a primary care practice (the Ypsilanti Health Center [YHC]) with local school-based health centers (the Regional Alliance for Healthy Schools [RAHS]), and to assess whether this model improves access to and quality of care for shared patients.Methods: Using the Consolidated Framework for Implementation Research, we define the steps in, barriers to, and facilitating factors in implementing the expanded medical home model. Visits and quality measures were assessed for patients seen by YHC only versus YHC/RAHS at baseline and during the intervention.Results: At baseline, patients seen at YHC/RAHS had higher compliance with most quality metrics compared with those seen at YHC only. The proportion of shared patients significantly increased because of the intervention (P < .001). Overall, patients seen in the expanded medical home had a higher likelihood of receiving quality metric services than patients in YHC only (odds ratio, 1.8; 95% confidence interval, 1.57-2.05) across all measures.Conclusions: Thoughtful and intentional implementation of an expanded medical home partnership between primary care physicians and school-based health centers increases the number of shared highrisk adolescent patients. Shared patients have improved compliance with quality measures, which may lead to long-term improved health equity. Adolescence is a critical stage in development in which health behaviors, including those that will last a lifetime, are adopted.1 These health behaviors are shaped by multiple social forces on personal, family, community, and national levels.2 These forces, also known as social determinants of health (SDOHs), are defined by the World Health Organization as "the conditions in which people are born, grow, live, work, and age," and are the influences that result in health inequities.3 HealthyPeople 2020, a national preventive health initiative in the United States, developed a framework to address 5 key areas of SDOHs. These notably include health and health care, a critical component of which is improving access to primary care.4 This is particularly applicable to the adolescent population who may experience numerous barriers to accessing health care, contributing to health inequities in this vulnerable population. 5The relationship between health outcomes and socioeconomic status (SES) has been well-researched; minority adolescents and those with low SES have been shown to have low rates of preven- tive care such as immunizations, poor management of common chronic diseases (eg, asthma and obesity), and limited access to mental health and substance abuse services. 6 -8 In addition, adolescents with low SES are less likely to have a source of primary care and yearly preventive visits. 8,9 Adolescents with low SES, those who are uninsured, and those who are members of black/Hispanic families are less likely to receive health care in a medical ho...

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“…Around 75% of lifetime mental health disorders present before 18 years,3 but there are often high levels of unmet need and long delays in accessing services, which increases the risk of ongoing mental health problems in adulthood 8. Outcomes of many long-term conditions are worse during adolescence and young adulthood than other stages of the life course: for example, diabetes control is worse than in either children or older adults 3…”

Section: The Need To Actmentioning

confidence: 99%

“…Paediatricians have a key role to play in ensuring a holistic, integrated approach is taken to meet adolescent health needs at local, national and international levels. There is increasing evidence that failure to do so can lead to avoidable ill health and increased need for healthcare services, both in the short term and in adult life 7 8. This article aims to guide paediatricians in answering the questions ‘How well are the public health and clinical needs of the adolescent population in my area being met?…”

Section: Introductionmentioning

confidence: 99%

Fifteen-minute consultation: public health for paediatricians—adolescent public health

Hargreaves¹,

Williams

Straw

et al. 2016

Arch Dis Child Educ Pract Ed

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Paediatricians have a key role to play in ensuring a holistic, integrated approach is taken to meeting adolescent health needs. There is increasing evidence that failure to do so can lead to poor healthcare experience, avoidable ill health and increased need for healthcare services, both in the short term and in adult life. This article aims to guide paediatricians in answering the questions 'How well are the public health and clinical needs of the adolescent population in my area being met? And how can we improve?'

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Unmet Health Care Need in US Adolescents and Adult Health Outcomes

Cited by 87 publications

References 21 publications

Unmet Health Services Needs Among US Children with Developmental Disabilities: Associations with Family Impact and Child Functioning

Unmet Health Services Needs Among US Children with Developmental Disabilities: Associations with Family Impact and Child Functioning

The Adolescent "Expanded Medical Home": School-Based Health Centers Partner with a Primary Care Clinic to Improve Population Health and Mitigate Social Determinants of Health

Fifteen-minute consultation: public health for paediatricians—adolescent public health

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