Primary Health Care Quality in a National Sample of Children and Youth with Mental Health Impairment

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Abstract
Objective: To examine the general pediatric health care quality experiences of children and youth with mental health impairment. Methods: We conducted a cross-sectional analysis of 2006 Medical Expenditures Panel Survey data for children and youth aged 5 to 17 years (n = 7263). Mental health impairment was defined using the recommended cut-point (score ≥16) on the parent version of the Columbia Impairment Scale. Health care quality was measured with the Consumer Assessment of Healthcare Providers and Systems including parent ratings in 3 domains: provider communication, getting needed care, and getting care quickly. Logistic regression was used to test associations between mental health impairment and dichotomized Consumer Assessment of Healthcare Providers and Systems measures (poor vs good quality) adjusted for demographic characteristics, health insurance, and socioeconomic status. Analysis was conducted with Stata, Version 10.1 SE, and all estimates accounted for the Medical Expenditures Panel Survey complex sampling design. Results: In multivariable analysis, health care experiences of children with mental health impairment (versus those without) were consistently rated less favorably by parents, with greater odds of inferior quality of care ratings in all domains: getting needed care (odds ratio [OR] = 2.35), getting care quickly (OR = 1.41), physician communication (OR = 1.72), and overall health care quality (OR = 1.63). Conclusions: Further research is needed to identify specific aspects of care that families find problematic in relation to the organization and delivery of care within each quality domain. Interventions are needed to improve service systems for children and youth with mental health impairment, especially to support access to needed care.

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