Individual and practice characteristics associated with physician provision of recommended care for children with special health care needs

Objective. To examine physician and practice characteristics associated with recommended care practices for children with special health care needs (CSHCN). Methods. A survey of primary care physicians (PCPs) in Arkansas with a Medicaid caseload of ≥100 children was conducted. Predictor variables included physician specialty field, demographics, practice type, and percentage of patients with public insurance. Multivariate regression analyses described predictors associated with recommended care practices informed by literature. Results. Of 565 mailed surveys, 203 (36%) were returned. Solo/2-person practice was associated with recommended care practices, including written care plan (adjusted odds ratio [AOR] = 9.67, 95% confidence interval [CI] = 2.61-35.8), providing extra time (AOR = 3.52, 95% CI = 1.47-8.43), and providing community referrals (AOR = 3.05, 95% CI = 1.33-7.02). Female gender was associated with extra time (AOR = 2.26, 95% CI = 1.07-4.78) and providing community referrals (AOR = 2.83, 95% CI = 1.30-6.18). Conclusion. Future studies should examine characteristics of smaller practices that drive implementation of recommended care practices.