In the United States, these are the patient-centered medical homes (PCMH) or patient-centered health homes, the equivalent of our multidisciplinary health homes (MSP) with the advantage of multidisciplinarity (doctors, nurses, assistants doctors, nutritionists, psychologists, etc.). And this primary care structure is extremely effective, in pediatrics too, explains this study from the University of Southern California. A health care solution, between the hospital and the home, which would also have a lot to contribute in the follow-up of children with specific health needs and more exposed to inequalities in terms of health care. In short, a local mission not to be neglected.
As in France, in the United States, the “medical house” (or PCMH) approach is essential to offer coordinated care also to the millions of children with special health needs. Two-thirds of children with health problems do not have access to appropriate care and their parents do not yet have the home care reflex, concludes Dr. Mónica Pérez-Jolles, from the University of Southern California. And health inequalities are more common in certain subgroups of pediatric patients, particularly in children with higher functional impairment.
Every child deserves a "medical home" , postulated the American Academy of Pediatrics: medical or health homes therefore have a specific role to play, this role of access to coordinated care already stated but especially for children with special needs: the authors point out that a representative American survey of the general population estimates that approximately 15% of children have special needs in terms of health care and that 23% of families have at least one child with special needs. The “PCMH” approach that focuses on accessible, family-centred, coordinated, comprehensive, culturally consistent, compassionate and high-quality care is tailored and even designed to meet the needs of these children.
This analysis of parent/caregiver experience through nationally representative data from the Medical Expenditure Survey (2003 to 2013) shows the full place of medical and nursing homes. The results suggest that:
- only 31% of children with special health care needs receive appropriate care, ie accessible, patient and family centred, comprehensive or multidisciplinary and supportive.
- 80% of children received comprehensive care and support;
- 60% benefited from accessible and patient-centered care;
- 87% of children with these special health needs have at least a moderate functional impairment: these children in particular are less likely to benefit from appropriate care;
- children from homes with low income and level of education also have more difficulty accessing this adapted care.
In summary, a little less than a third of children with specific health care needs have access to care such as that provided in medical or health centres.
Thus, despite significant investment in these new structures, "there is still a long way to go to 'reach' all these children in need of care".
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