Health Service Utilization Patterns Research Articles

Association between the continuum of care and postpartum depression among Angolan mothers

BackgroundThis study investigated the association between maternal and child health service utilization patterns and postpartum depression (PPD). MethodsThis study analyzed a dataset of women who participated in a randomized controlled trial to examine the effectiveness of the Maternal and Child Health Handbook in Angola. We defined probable PPD as an Edinburgh Postpartum Depression Scale (EPDS) score ≥ 10. The EPDS was administered at approximately 6 months postpartum. Service utilization patterns were defined using numbers of antenatal care (ANC), facility delivery, and vaccination visits by 6 months postpartum. The association between service utilization patterns and PPD was examined using logistic regression analyses adjusting for socioeconomic factors and parity. The continuum of care (CoC) complete pattern (four ANC/facility delivery/four vaccination) was used as a reference. ResultsThe data of 7087 participants whose children were alive and aged 6 months or older at the endline survey were analyzed. Prevalence of PPD was 17.9 % in urban and 43.2 % in rural municipalities. In urban municipalities, dropouts from the CoC at delivery and after delivery had significantly higher odds of PPD (AOR = 1.45, 95 % CI = 1.00–2.10; AOR = 1.57, 95 % CI = 1.24–1.99). In rural municipalities, dropouts from the CoC after delivery (AOR = 1.60, 95 % CI = 1.12–2.28) had significantly higher odds of PPD. LimitationsThe onset of depressive symptoms was not assessed. The EPDS was validated in some Portuguese speaking countries but not in Angola. ConclusionPPD was associated with irregular service utilization patterns such as dropouts from the CoC. Therefore, CoC and mental health must be promoted simultaneously.

Health service utilisation by quota, family-sponsored and convention refugees in their first five years in New Zealand

ObjectiveThis study examines and compares health service utilisation patterns between New Zealand’s (NZ) three main refugee groups and the general NZ population. MethodsWe used Statistics NZ’s Integrated Data Infrastructure to identify quota, family-sponsored and convention refugees arriving in NZ (2007–2013). We analysed contact with primary care, emergency department (ED), and specialist mental health services for the first five years in NZ. Logistic regression models, adjusted for age, sex and deprivation, compared health service use between refugee groups and the general NZ population in years 1 and 5. ResultsQuota refugees were more likely to be enrolled and in contact with primary care and specialist mental health services in year 1 than family-sponsored and convention refugees, but differences reduced over time. All refugee groups were more likely than the general NZ population to have presented to ED in year 1. ConclusionsQuota refugees were better connected with health services in year 1 than the other two refugee groups. The types of frontline health services accessed by refugee groups differed from the general NZ population. Implications for Public HealthThere should be systematic and equal support across all NZ regions to help refugees (regardless of visa type) navigate the NZ health system.

Age and gender patterns in health service utilisation: Age-Period-Cohort modelling of linked health service usage records

BackgroundHealth service utilisation changes across the life-course and may be influenced by contextual factors at different times. There is some evidence that men engage less with preventive health services, including attending doctors’ clinics, however the extent to which this varies temporally and across different age groups is unclear. This study aimed to describe age or cohort effects on engagement with GPs among employed mothers and fathers in Australia, and differences in these trends between men and women.MethodsWe linked data from the ‘Growing up in Australia: The Longitudinal Study of Australian Children’ with administrative health service records from Medicare. We used a small-domain estimation Age-Period-Cohort method to describe patterns in health service use among working-age male and female parents in Australia while adjusting for employment status and controlling for time-invariant factors. Our small-domain method assumes a smooth response surface of Age, Period and Cohort.ResultsMale parents have lower health service engagement than women of the same age at the same time period. Men’s pattern of health service use across time is likely explained entirely by ageing. That is, we find that patterns in health service utilisation among men are largely driven by age effects, with no evidence of periods or cohort effects in health service engagement for men between 2002 and 2016.ConclusionsDifferences in health service utilisation between male and female parents at all age-period-cohort combinations highlight a need for more research to examine the extent to which this level of health service use among Australian men meets men’s health needs, as well as barriers and enablers of health service engagement for men. Absence of evidence for period effects suggests that there is little shift in gendered patterns of health service utilisation during the observed period.

Patterns of Health Services Utilization During Pregnancy, Delivery, and Postpartum Period: Evidence from Pakistan Maternal Mortality Survey

Utilization of health services is a multidimensional behavioural phenomenon, particularly when it comes to pregnancy and delivery concerns. The importance of maternal health care services in reducing maternal mortality and morbidity has received a significant recognition. Most of the maternal deaths can be prevented if women have access to basic antenatal, delivery and postnatal care. However, uptake of maternal health care services is very low even in the areas where they are extensively available. The aim of this study is to assess the pattern and identify underlying factors on maternal health care utilization in Pakistan. Data is taken from Pakistan Maternal Mortality Survey (PMMS) 2019. Logistic regression was performed and adjusted odd ratios were calculated by using three dependent variables – Ideal Antenatal Care (IANC), birth assisted by Skilled Birth Attendant (SBA), and Postnatal Care (PNC). Impact of biological and socio-demographic variables were computed, and findings revealed that with the increase in age, education and household wealth, women are more likely to have better opportunities to use ANC, SBA and PNC. The focus of policy considerations should be on the provision of high-quality services as well as on educating women about the value of receiving such services during pregnancy and the postpartum period through education and awareness campaigns. Moreover, skilled staff and voluntary health workers can be recruited to make future agendas in reducing maternal mortality and morbidity more successful.

Mental Health Services Utilization among Suicidal Patients: Comparing the Impact of Co-Occurring Opioid or Other Substance Use Disorders

IntroductionPrior literature establishes bidirectional associations between suicide and substance use disorders (SUDs), particularly opioid use disorder (OUD). However, the context of mental health services utilization remains under-investigated. This analysis examined patterns of mental health services utilization in patients with SUDs and suicidality, identified associated risk factors, and evaluated the impact of patient engagement on subsequent mental health outcomesObjectivesSee above.MethodsElectronic health records (EHRs) derived from 7 health systems across New York City between 2010-2019 were analyzed. Suicidality was identified as any ICD-9/10 diagnosis of suicide attempt, suicidal ideation, or self-harm injury. SUDs were identified as any opioid, cannabis, cocaine, hallucinogen, inhalant, sedative/hypnotic/anxiolytic, amphetamine, or other substance abuse or dependence. Quasi-Poisson regression adjusted for age, gender, and chronic diseases was used to model associations between OUD exposure and the frequency of encounters and estimate the relative risk (RR) of significant covariates.ResultsA total of 6977 adults with suicidality and any comorbid SUD were selected, including 2203 (31.6%) with a diagnosis of OUD and 4774 (68.4%) without a diagnosis of OUD. Most patients were male (54.8%) and aged between 25-64 years (79.3%). Many (61.3%) had over 3 chronic diseases, including depression (80.8%), hypertension (60.6%), anemia (43.0%), and hyperlipidemia (41.9%). Compared to patients with other SUDs, those with OUD had higher odds of self-harm injury [OR: 1.26 (95% CI: 1.13-1.41)], depressive disorders [1.47 (1.29-1.67)], anxiety disorders [1.65 (1.48-1.84)], psychotic disorders [1.23 (1.11-1.37)], personality disorders [1.30 (1.16-1.48)], and post-traumatic stress disorder [1.37 (1.20-1.57)]. Patients with OUD were more likely to utilize all-cause outpatient (RR: 1.16), emergency department (ED) (RR: 1.43), and inpatient (RR: 1.60) services (p<0.001). Among OUD patients, males were less likely to have outpatient visits (RR: 0.79) and inpatient hospitalizations (RR: 0.88), and older age was protective against ED admissions (RR range: 0.62-0.71). Additionally, individuals with OUD were more likely than those with other SUDs to have SUD-related encounters, as well as suicide-related ED admissions and inpatient hospitalizations (p<0.0001). Those who had more mental health outpatient visits were less likely to have suicide-related ED admissions (RR: 0.85), however this association was weaker among younger or male patients with comorbid OUD.ConclusionsAmong suicidal adults with comorbid SUDs, those with a diagnosis of OUD were more likely to utilize mental health services and have psychiatric comorbidity. Males and older adults were less likely to utilize services.Disclosure of InterestNone Declared

Patterns of Health Services Utilization During Pregnancy, Delivery, and Postpartum Period: Evidence from Pakistan Maternal Mortality Survey

Utilization of health services is a multidimensional behavioural phenomenon, particularly when it comes to pregnancy and delivery concerns. The importance of maternal health care services in reducing maternal mortality and morbidity has received a significant recognition. Most of the maternal deaths can be prevented if women have access to basic antenatal, delivery and postnatal care. However, uptake of maternal health care services is very low even in the areas where they are extensively available. The aim of this study is to assess the pattern and identify underlying factors on maternal health care utilization in Pakistan. Data is taken from Pakistan Maternal Mortality Survey (PMMS) 2019. Logistic regression was performed and adjusted odd ratios were calculated by using three dependent variables – Ideal Antenatal Care (IANC), birth assisted by Skilled Birth Attendant (SBA), and Postnatal Care (PNC). Impact of biological and socio-demographic variables were computed, and findings revealed that with the increase in age, education and household wealth, women are more likely to have better opportunities to use ANC, SBA and PNC. The focus of policy considerations should be on the provision of high-quality services as well as on educating women about the value of receiving such services during pregnancy and the postpartum period through education and awareness campaigns. Moreover, skilled staff and voluntary health workers can be recruited to make future agendas in reducing maternal mortality and morbidity more successful.

Examining Patterns of Psychotherapy Service Utilization Among Medicaid-Enrolled Adolescents.

Adolescents with behavioral health disorders (i.e., mental health disorders and substance use) often experience frequent recurrence of symptoms, suggesting a need for an ongoing behavioral health intervention, rather than a single course of treatment. However, little is known about mental health care service use among adolescents over longer periods. The authors examined longitudinal patterns of outpatient behavioral health service utilization in a large sample of adolescents. Medicaid claims for 8,197 adolescents (ages 10.0-13.9 years, mean±SD=11.5±1.2; 61% male) from one Indiana county between 2006 and 2017 were examined, with a focus on outpatient psychotherapy visits. Latent class analysis (LCA) was used to detect clusters of longitudinal patterns of outpatient psychotherapy visits across 5 years, beginning with an adolescent's first behavioral health visit. A five-class LCA model emerged with unique classes of service use based on duration and level of engagement (frequency) of monthly outpatient psychotherapy visits. Most adolescents fell in the nonuse class (38.7% of the sample). Additional classes were defined as late-onset low engagement (17.1%), early-onset high engagement (15.5%), early-onset moderate engagement (16.7%), and continuously high engagement (11.9%). Statistically significant differences were found across the classes in average duration and frequency of involvement (p<0.001), as well as in demographic characteristics (race, age, gender, and ethnicity) and behavioral health diagnoses (p<0.001). These findings confirm that adolescents with behavioral health diagnoses do not follow a uniform pattern of psychotherapy utilization. The distinct patterns of service use point toward the need to identify appropriate long-term service recommendations for adolescents.

Beyond Purdah: Understanding the Barriers Indian Muslim Women Face in Accessing and Utilizing Maternal Health Services

Several analysts have found that the utilization rates of maternal health services, such as antenatal care visits, skilled birth attendants and institutional deliveries are lower among Muslim women relative to women of other religious groups in India. Some have attributed this to the religiosity of Muslim women, among other social determinants such as income, education, class, and parity. These authors highlight that religious practices such as purdah play a significant role in shaping Muslim women’s reluctance to access maternal services. They report that Muslim women prefer not to access facilities with male providers, and that they lack decision making autonomy regarding their reproductive health. In this article, I will uncover the limitations underlying their arguments. I present an alternate argument: Muslim women’s utilization patterns of maternal health services may be better explained by systemic factors such as financial barriers, the historical mistrust of government health services, health communication disparities, and discrimination against Muslim women by healthcare professionals. This article argues for public health researchers to adopt a sociopolitical lens in explaining and contextualizing the barriers women belonging to excluded, minoritized, or marginalized caste and religious groups in India face in accessing maternal care.

Social and structural determinants of emergency department use among Arab and Jewish patients in Jerusalem

BackgroundA growing body of research demonstrates that economic conditions and racial and ethnic disparities result in excessive overuse of emergency departments (EDs) by a small group of socioeconomically marginalized residents. Knowledge and understanding of these issues on the part of the healthcare team can promote equality by providing structurally competent care. This study aims to identify the major social and structural factors related to patterns of ED visits by Arab and Jewish patients in Israel, where access to health services is covered by universal national health insurance.MethodsA cross-sectional study was conducted using questionnaires of ED patients in a tertiary care medical center in Jerusalem. The hospital is the largest of the three EDs in Jerusalem with over 90,000 adult patient visits a year. The sample was stratified by ethnicity, including 257 Jewish patients and 170 Arab patients. The outcome variable was repeat visits for the same reason to the ED within 30 days.ResultsThere were differences between Jewish and Arab patients’ social and structural characteristics, including health status, socioeconomic status, feeling of safety, and social support. There were also significant differences in some of the characteristics of health service utilization patterns, including ED repeat visits, language barriers when seeking healthcare in the community, and seeking information about medical rights. The variables associated with repeat visits were different between the two groups: among the Arab patients, repeat visits to the ED were associated with concerns about personal safety, whereas among the Jewish patients, they were associated with poverty.ConclusionThe study illustrates the gaps that exist between the Arab and Jewish population in Israel. The findings demonstrated significant differences between populations in both health status and access to health services. In addition, an association was found in each ethnic group between different structural factors and repeat ED requests. This study supports previous theories and findings of the relationship between structural and social factors and patterns of health services utilization.

Responding to Ontario's Overdose Crisis in the Context of the COVID-19 Pandemic.

The COVID-19 pandemic has exacerbated the overdose crisis in Canada. Using data from ICES and the Office of the Chief Coroner of Ontario, the authors characterized changing patterns of medication use and health services utilization during the pandemic. This analysis suggests that responses to the overdose crisis must confront the rapidly changing unregulated drug supply with a tailored response that addresses varied population needs, expands accessible treatment and harm reduction services and responds to the missed opportunities for engagement and support within various healthcare settings.

Leading causes of excess mortality in Mexico during the COVID-19 pandemic 2020–2021: A death certificates study in a middle-income country

SummaryBackgroundThe death toll after SARS-CoV-2 emergence includes deaths directly or indirectly associated with COVID-19. Mexico reported 325,415 excess deaths, 34.4% of them not directly related to COVID-19 in 2020. In this work, we aimed to analyse temporal changes in the distribution of the leading causes of mortality produced by COVID-19 pandemic in Mexico to understand excess mortality not directly related to the virus infection.MethodsWe did a longitudinal retrospective study of the leading causes of mortality and their variation with respect to cause-specific expected deaths in Mexico from January 2020 through December 2021 using death certificate information. We fitted a Poisson regression model to predict cause-specific mortality during the pandemic period, based on the 2015–2019 registered mortality. We estimated excess deaths as a weekly difference between expected and observed deaths and added up for the entire period. We expressed all-cause and cause-specific excess mortality as a percentage change with respect to predicted deaths by our model.FindingsCOVID-19 was the leading cause of death in 2020–2021 (439,582 deaths). All-cause total excess mortality was 600,590 deaths (38⋅2% [95% CI: 36·0 to 40·4] over expected). The largest increases in cause-specific mortality, occurred in diabetes (36·8% over expected), respiratory infections (33·3%), ischaemic heart diseases (32·5%) and hypertensive diseases (25·0%). The cause-groups that experienced significant decreases with respect to the expected pre-pandemic mortality were infectious and parasitic diseases (-20·8%), skin diseases (-17·5%), non-traffic related accidents (-16·7%) and malignant neoplasm (-5·3%).InterpretationMortality from COVID-19 became the first cause of death in 2020–2021, the increase in other causes of death may be explained by changes in the health service utilization patterns caused by hospital conversion or fear of the population using them. Cause-misclassification cannot be ruled out.FundingThis study was funded by Conacyt.

Patterns of health service utilisation of mothers experiencing mental health problems and intimate partner violence: Ten-year follow-up of an Australian prospective mother and child cohort

Patterns of health service utilisation of mothers experiencing mental health problems and intimate partner violence: Ten-year follow-up of an Australian prospective mother and child cohort

Patterns of health service utilisation of mothers experiencing mental health problems and intimate partner violence: Ten-year follow-up of an Australian prospective mother and child cohort.

Few studies have investigated health service use of mothers experiencing mental health problems or intimate partner violence (IPV). The aim of this study was to investigate health service utilisation of mothers experiencing mental health problems and intimate partner violence ten years after having a first baby. Prospective cohort of 1507 first-time mothers recruited in Melbourne, Australia. Follow-up at ten years incorporated: Center for Epidemiologic Studies Depression Scale, Beck Anxiety Inventory, Posttraumatic Stress Disorder Checklist, Composite Abuse Scale. At ten years postpartum, one in four mothers (26.1%) reported depressive, anxiety or posttraumatic stress symptoms, and almost one in five (19.4%) reported recent IPV. Two-fifths of mothers reporting clinically significant mental health symptoms had experienced recent IPV (Odds Ratio = 5.6, 95% CI 3.9-8.1). Less than half of mothers experiencing mental health problems at ten-year follow-up had discussed their mental health with a general practitioner and around one in three had talked to a mental health professional. Two-thirds of mothers experiencing recent IPV had not disclosed this to a general practitioner or mental health professional. The findings highlight the extent to which many women deal with IPV and mental health problems without the support that primary health care and mental health care could provide and point to the need for more concerted efforts to strengthen health system responses to these frequently related issues.

Distributive Pattern of Health Services Utilization Under Public Health Reform and Promotion in Turkey

Objectives: Inclusive health policies and health promotion to ensure strong primary healthcare systems are main tenets of health reforms in developing countries, such as Turkey. Nevertheless, there has been a lack of interest regarding the assessment of equity in health services utilization under public health reform and promotion of primary care. This study aims to analyze equity by measuring deviations from proportionality in the relationship between the utilization of health services and income using indices and curve approaches. MethodsA cross-sectional national Turkey Health Survey used the years 2008, 2010, 2012, and 2014. Gini and Kakwani indices and concentration curves were estimated, and the degree of regressivity was analyzed to understand the sources of equity in health services utilization. ResultsHealth services utilization for inpatient and outpatient services and family medicine and general practitioner services were regressive between the years 2008 and 2014. The most regressive pattern was observed in the year 2014 regarding medicine usage (Kakwani index = –0.1808904). ConclusionsDifferences in the utilization of health services have increased, hurting the poorest during the health reform in Turkey. Policies focused on health promotion to strengthen the primary health system and continuous monitoring of health services utilization by vulnerable groups are essential for ensuring a fairer health service usage in developing countries.

Mental health needs assessment of individuals experiencing homelessness in Charleston, South Carolina.

More than 4,268 people were experiencing homelessness in South Carolina during the 2020 point in time count, with Charleston county ranked the 4th highest in the state for number of individuals experiencing homelessness. Mental health disorders often contribute to or result from housing insecurity. The purpose of this quality improvement study was to determine mental health needs, and mental health services utilization patterns of people experiencing homelessness or housing insecurity (PEH) in Charleston, SC. Cross sectional survey, utilizing a 13 question paper survey. Drop-in resource center for PEH. 33 PEH accessing the resource center. 1. Demographics 2. Mental health needs 3. Access to mental health resources and 4. Preferences for accessing mental health services. Survey participants (n=33) ranged from 19 to 64 years old with 57.6% identifying as male and 51.5% identifying as Black. More than three quarters (81.3%) of those surveyed reported being diagnosed with at least one psychiatric disorder. Over half (56.3%) had been hospitalized for a psychiatric reason. Over two thirds (70.0%) were accessing some form of mental health service and 51.9% endorsed some difficulty accessing prescribed psychiatric medications. Cost and transportation were selected most often as barriers to access. Most participants (92.9%) were interested in receiving some form of mental health service and 62.5% said access to services would make it easier to get stable housing. Most (85.2%) were willing to access mental health services virtually, however, 50.0% of participants did not report access to an electronic device and most (74.1%) denoted preference for in person services. PEH have significant mental health needs and experience barriers to accessing mental health services. Resources directed at addressing these barriers are essential to improve the mental health of this vulnerable population and ameliorate housing instability.

Mental Health Service Utilization Among Medical Students with a Perceived Need for Care

The authors investigated levels of perceived need for help, patterns of mental health service utilization, and barriers to care among US medical students with a focus on students who perceived a need for help but did not report service use in the past 12months. The authors administered an online survey to 2,868 medical students at three schools in Ohio between January and February 2020 including validated scales for psychological distress, self-stigma, and an exploration of mental health treatment. The authors used multivariable logistic regression to identify factors associated with treatment and qualitative analysis to identify common barriers to care. Twenty-eight percent (N = 800) of 2,868 students responded to the survey. Fifty-six percent (n = 439) of students reported a perceived need for help, while 34.6% of these respondents (n = 152) did not receive treatment. Among those with perceived need who completed the survey (n = 388), Asian students compared to non-Hispanic white students (adjusted odds ratio [aOR] = 0.45, 95% confidence interval [CI] 0.25-0.82) and those with higher self-stigma (aOR = 0.90, 95% CI 0.87-0.94) had lower odds of service use. Students told by others to seek help (aOR = 2.82, 95% CI 1.71-4.64) were the only group with higher odds of service use. The most common barriers to care were lack of time, difficulty accessing services, and stigma. Despite a perceived need for help, many students do not seek care and experience treatment barriers. Schools can encourage help-seeking by identifying students in need, using targeted messaging, fostering a low-stigma environment, and removing barriers.

Patterns of Child Mental Health Service Utilization Within a Multiple EBP System of Care

The current study (1) characterizes patterns of mental health service utilization over 8 years among youth who received psychotherapy in the context of a community implementation of multiple evidence-based practices (EBPs), and (2) examined youth-, provider- and service-level predictors of service use patterns. Latent profile analyses were performed on 5,663,930 administrative claims data furnished by the county department of mental health. Multinomial logistic regression with Vermunt’s method was used to examine predictors of care patterns. Based on frequency, course, cost, and type of services, three distinct patterns of care were identified: (1) Standard EBP Care (86.3%), (2) Less EBP Care (8.5%), and (3) Repeated/Chronic Care (5.2%). Youth age, ethnicity, primary language, primary diagnosis and secondary diagnosis, provider language and provider type, and caregiver involvement and service setting were significant predictors of utilization patterns. Although the majority of youth received care aligned with common child EBP protocols, a significant portion of youth (13.7%) received no evidence-based care or repeated, costly episodes of care. Findings highlight opportunities to improve and optimize services, particularly for youth who are adolescents or transition-aged, Asian-American/Pacific Islander, Spanish-speaking, or presenting with comorbidities.

Using Twitter Comments to Understand People's Experiences of UK Health Care During the COVID-19 Pandemic: Thematic and Sentiment Analysis.

BackgroundThe COVID-19 pandemic has led to changes in health service utilization patterns and a rapid rise in care being delivered remotely. However, there has been little published research examining patients’ experiences of accessing remote consultations since COVID-19. Such research is important as remote methods for delivering some care may be maintained in the future.ObjectiveThe aim of this study was to use content from Twitter to understand discourse around health and care delivery in the United Kingdom as a result of COVID-19, focusing on Twitter users’ views on and attitudes toward care being delivered remotely.MethodsTweets posted from the United Kingdom between January 2018 and October 2020 were extracted using the Twitter application programming interface. A total of 1408 tweets across three search terms were extracted into Excel; 161 tweets were removed following deduplication and 610 were identified as irrelevant to the research question. The remaining relevant tweets (N=637) were coded into categories using NVivo software, and assigned a positive, neutral, or negative sentiment. To examine views of remote care over time, the coded data were imported back into Excel so that each tweet was associated with both a theme and sentiment.ResultsThe volume of tweets on remote care delivery increased markedly following the COVID-19 outbreak. Five main themes were identified in the tweets: access to remote care (n=267), quality of remote care (n=130), anticipation of remote care (n=39), online booking and asynchronous communication (n=85), and publicizing changes to services or care delivery (n=160). Mixed public attitudes and experiences to the changes in service delivery were found. The proportion of positive tweets regarding access to, and quality of, remote care was higher in the immediate period following the COVID-19 outbreak (March-May 2020) when compared to the time before COVID-19 onset and the time when restrictions from the first lockdown eased (June-October 2020).ConclusionsUsing Twitter data to address our research questions proved beneficial for providing rapid access to Twitter users’ attitudes to remote care delivery at a time when it would have been difficult to conduct primary research due to COVID-19. This approach allowed us to examine the discourse on remote care over a relatively long period and to explore shifting attitudes of Twitter users at a time of rapid changes in care delivery. The mixed attitudes toward remote care highlight the importance for patients to have a choice over the type of consultation that best suits their needs, and to ensure that the increased use of technology for delivering care does not become a barrier for some. The finding that overall sentiment about remote care was more positive in the early stages of the pandemic but has since declined emphasizes the need for a continued examination of people’s preference, particularly if remote appointments are likely to remain central to health care delivery.

Youth mental health service preferences and utilization patterns among Latinx caregivers

Latinx caregivers underutilize traditional youth mental health services (MHS) relative to their White counterparts. Disparities may be explained by barriers preventing engagement in traditional MHS. A potential mismatch between available services and preferred culturally appropriate healing practices may also contribute to treatment disparities. The current study examined Latinx caregivers’ perceived need for and utilization of support services in relation to family characteristics, youth problem-type, and barriers to care. Findings were contextualized by assessing caregiver preferences for addressing youth psychopathology. The study consisted of 598 Latinx caregivers from across the United States. Descriptive statistics and binary logistic regression models were used to conduct exploratory analyses. The most frequently used sources of support for youths were medical doctors, school professionals, family or friends, psychological counseling or therapy, and parenting classes. Caregiver perceived need for and utilization of services was generally greater among youths with clinically elevated internalizing or externalizing problems. While Latinx caregivers report needing and utilizing a variety of services to address youth psychopathology, they frequently ranked psychological counseling as their most preferred format. Problem-specific service need and utilization was found for medical (i.e., clinical internalizing problems) and religious services (i.e., minister or faith healer; clinical externalizing problems). Youth and family characteristics and barriers to care were differentially associated with service need and utilization across formats. Our findings suggest a need to increase access to youth psychological counseling services among Latinxs and highlight additional avenues for integrating MHS into formats that caregivers frequently report needing and utilizing.

Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation.

Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation.