Transition to adult care services for youth with sepcial health care needs

Background:

The purpose of this study was to determine if the primary care physician scope of practice (pediatrics versus general practice) is associated with receipt of transition services for youth with special health care needs (YSHCN).

Methods:

Data from the National Survey of Children with Special Health Care Needs, 2009-2010 were analyzed to determine the association between physician scope of practice (pediatrics only versus general practice) and transition to adult care services (physician discussed YSHCN’s adult health care needs, insurance coverage as adult, and taking responsibility for his/her own health care needs).  Logistic regression was performed controlling for race/ethnicity, age (≥12 years), gender, highest household education, insurance status, federal poverty level, relationship of responder to child, and severity of condition.

Results:

In adjusted analyses, pediatrics only practitioners were associated with decreased odds of discussing adult health care needs [OR:0.77; 95%CI(0.68-0.87)] and increased odds of encouraging YSHCN to take responsibility for his/her needs [OR:1.16: 95%CI(1.00-1.36)]. Scope of practice was not associated with discussing adult insurance coverage. Age, gender, insurance status, relationship of respondent to YSHCN, and severity of condition were also associated with transition services. 

Conclusions:

Physician scope of practice is associated with some transition to adult care services for YSHCN.  A narrow scope of services may be detrimental to YSHCN receiving optimal care.  This should be monitored for the development and implementation of programs/policies responsive to the Affordable Care Act.