Specialty care shortage leads to lower perceived need for it

(HealthDay)—Children with special health care needs living in counties with lower subspecialty supply have lower perceived need for subspecialty care, according to a study published online May 5 in Pediatrics.

Kristin N. Ray, M.D., from the University of Pittsburgh, and colleagues calculated pediatric subspecialists per capita in each U.S. residential county. The National Survey of Children With Special Health Care Needs (2009 to 2010) was used to assess the association between quintile of pediatric subspecialty supply and parent-reported subspecialty utilization, perceived subspecialty need, and child and family disease burden.

The researchers found that county-level pediatric subspecialty supply ranged from a median of 0 (lowest quintile) to 59 (highest quintile) per 100,000 children. Children in the lowest quintile of supply were 4.8 percent less likely to report ambulatory subspecialty visits (P < 0.001), 5.3 percent less likely to perceive subspecialty care needs (P < 0.001), and 2.3 percent more likely to report emergency department visits (P = 0.018), compared to children in the highest quintile, after adjusting for other factors.

"Children living in counties with the lowest supply of pediatric subspecialists had both decreased perceived need for subspecialty care and decreased utilization of subspecialists," the authors write.

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