Rural and nonrural differences in providing care for children with complex chronic conditions.

To better understand the challenges faced by primary care providers in rural locations in providing care for children with complex chronic conditions (CCC), the authors conducted a cross-sectional survey of primary care providers (N = 132), including physicians, nurse practitioners, and physician assistants, in community settings in 6 counties in northwest North Carolina. Pediatric practices were significantly less likely to be located in rural areas. Practices in rural areas were more likely to be small, with fewer staff members (odds ratio [OR] = 7) and providers (OR = 15) compared with practices in nonrural areas. Additionally, nonrural practices were 3 times as likely as rural practices to have a larger clientele of children with CCC. A majority of primary care providers (77%) reported difficulty caring for children with CCC. Strategies for supporting primary care providers are needed to enable them to provide care for the growing number of children with CCC.