Health Visitors Research Articles

Patient-Centered Care in Action: How Clinicians Respond to Patient Dissatisfaction with Contraceptive Side Effects.

Patient-centered care is widely cited as a component of quality contraceptive health care, but its operationalization in clinical interaction is contested. This article examines patient-centered care as an interactional phenomenon using the case of patient dissatisfaction with side effects of hormonal contraceptive medications. Drawing on transcript data from 109 tape-recorded reproductive health visits, I find that provider responses to treatment dissatisfaction range from patient-centered to relatively authoritarian. Providers typically offer patient-centered responses that validate patient experiences and integrate them into contraceptive counseling and method selection. At the same time, explicit communication about patients' contraceptive priorities is rare. In its absence, providers use patient-centered communication to smooth the interactional path toward uptake of highly effective hormonal methods, mostly ignoring the possibility that some patients may prefer less effective methods. Patient-centered contraceptive care was circumscribed by the clinical goal of pregnancy prevention.

Information work and digital support during the perinatal period: Perspectives of mothers and healthcare professionals.

During pregnancy and early motherhood, the perinatal period, women use a variety of resources including digital resources to support social interactions, information seeking and health monitoring. While previous studies have investigated specific timepoints, this study takes a more holistic approach to understand how information needs and resources change over the perinatal period. Furthermore, we include the perspective of maternity healthcare professionals to better understand the relationship between different stakeholders in the information work of perinatal women. A total of 25 interviews with 10 UK based mothers and 5 healthcare professionals (3 Midwives and 2 Health visitors) were conducted. Perinatal women were asked about their information and support needs throughout pregnancy and the postnatal period, healthcare professionals were asked about information and support provision to perinatal women. Information work activities were grouped along stages of the perinatal timeline from pre-pregnancy to the postanal period to illustrate the work and perspectives of the women and the healthcare professionals. Information work varies considerably over the timeline of the perinatal period, shifting back and forth in focus between mother and baby. information work during this period consists of many information related activities including seeking, monitoring, recording, questioning, sharing and checking. The importance of the HCPs as stakeholders in this work is notable as is the digital support for information work. Importantly, paper-based resources are still an important shared resource allowing reflection and supporting communication. Information work for women varies across the perinatal timeline. Particular challenges exist at key transition points, and we suggest design considerations for more integrated digital resources that support information work focused on mother and baby to enhance communication between perinatal women and healthcare professionals.

Feasibility of aging in place clinics in low income senior housing

The purpose of this study was to describe the feasibility of implementing interdisciplinary senior housing clinics. Feasibility was based on evidence of resident participation, services provided, improvement in clinical outcomes and sustaining clinics over time. Data were collected prospectively in four senior housing communities which included approximately 375 residents 60 years of age and older. Over the 12-month implementation period, 228 residents were seen, 61 % of all residents. We gave 131 immunizations, checked 576 blood pressures, completed 92 foot care treatments, 69 hearing evaluations and cerumen removal, completed 16 advance directives, 119 Annual Wellness Visits, and 13 assessments for acute medical problems. Overall, 87 individuals (38 %) had a decrease in their blood pressures, 121 (54 %) maintained their pressures and 19 (8 %) had increases in blood pressures. We reached over half of the residents living in these communities and estimated we could financially maintain the clinics with reimbursement based on billing.

Vaccine patterns among older adults with Guillain-Barré syndrome and matched comparators, 2006-2019.

Some vaccines have a small risk of triggering Guillain-Barré syndrome (GBS), an autoimmune disorder where nerve damage leads to paralysis. There is a CDC precaution for patients whose GBS was associated with an influenza or tetanus toxoid-containing vaccine (GBS occurring within 42 days following vaccination). We described vaccine patterns before and after a GBS diagnosis with a matched cohort design in a 20% random sample of fee-for-service Medicare enrollees. We defined the index date as an ICD-9-CM or ICD-10-CM GBS diagnosis code in the primary position of an inpatient claim. We matched each GBS patient to five non-GBS comparators on sex, exact age, racial and ethnic category, state of residence and the month of preventive health visits during baseline; used weighting to balance covariates; and measured frequency of vaccines received per 100 people during year before and after the index date using the weighted mean cumulative count (wMCC). We identified 1567 patients with a GBS diagnosis with at least 1 year of prior continuous enrollment in Medicare A and B that matched to five comparators each. The wMCCs in the 1 year before the index date were similar for both groups, with a wMCC of 74 vaccines/100 people in the GBS group (95% CI 71, 77). Within 1 year after the index date, patients with GBS had received 26 vaccines/100 people (95% CI 23, 28), which was 41 fewer vaccines than matched non-GBS comparators (95% CI -44, -38). Among GBS patients, 11% were diagnosed with GBS within 42 days after a vaccine. GBS diagnosis has a strong impact on reducing subsequent vaccination even though there is no warning or precaution about future vaccines for most patients diagnosed with GBS. These data suggest discordance between clinical practice and current vaccine recommendations.

Assessment of airborne infection control practices at health care facilities of Tumkur District, Karnataka: A descriptive study

IntroductionTuberculosis (TB) is a major health hazard in India and is one of the leading causes of death worldwide. Airborne transmission of infectious disease is a major public health concern. Adherence to the airborne infection control (AIC) is crucial to prevent spread of TB among patients who visit health care facilities and among the health care staff. ObjectivesTo assess the airborne infection control practices at health care facilities of Tumkur Methodology: This descriptive study was conducted in 85 public health institutes in 5 TB units of Tumkur. Data was collected using pre-tested; semi-structured questionnaire through personal interview, verification of records and inspection using WHO check-list. ResultsThe present study showed infection control committee and infection control plan were present in 97.65% and 90.59%, clinical staff underwent periodic TBIC training in 91.76% of PHIs. Waiting area and sputum sample collection area were well-ventilated in 97.65% & 97.65% of PHIs. Health workers practiced hand hygiene in 90.59%, PPEs were available in 85.06% PHIs. ConclusionThe study concludes that, airborne infection control measures which includes administrative, environmental, and use of personal protective equipment were satisfactory among the PHIs but still there is scope for improvement.

Views and experiences of health visitors on an early literacy promotion intervention

Background: The advantages of early literacy activities in promoting infant and child development have been well documented in the literature as well as the effectiveness of relevant interventions implemented by health professionals. Yet, data on the perceptions and attitudes of primary health care providers about the implementation process of such interventions remain scarce. Objective: The aim of this qualitative study was to explore the experiences and views of health visitors (n=13) in applying an early literacy promotion intervention during their practice in primary health settings. Methods: Data were collected through questionnaires with open ended questions and analyzed through thematic analysis. Results: Findings showed that parents welcomed the advice and were willing to introduce literacy-oriented activities with their children in their daily family routine. Parents’ and children’s receptiveness as well as health visitors’ own belief in the significance of the intervention were considered factors largely facilitating its implementation and success, despite time constrains and system level shortcomings. Continuing education was recommended both to provide constant support to health visitors, and also sensitize other members of the primary care team for program sustainability and expansion. Conclusions: The results of this study highlighted the importance of recording health professionals’ views, concerns and experiences on applying early literacy promotion so as to receive feedback on ameliorating relevant programs and maximizing their valuable impacts on infant and child development.

Assessing how frailty and healthcare delays mediate the association between sexual and gender minority status and healthcare utilization in the All of Us Research Program.

To understand how frailty and healthcare delays differentially mediate the association between sexual and gender minority older adults (OSGM) status and healthcare utilization. Data from the All of Us Research Program participants ≥50 years old were analyzed using marginal structural modelling to assess if frailty or healthcare delays mediated OSGM status and healthcare utilization. OSGM status, healthcare delays, and frailty were assessed using survey data. Electronic health record (EHR) data was used to measure the number of medical visits or mental health (MH) visit days, following 12 months from the calculated All of Us Frailty Index. Analyses adjusted for age, race and ethnicity, income, HIV, marital status ± general MH (only MH analyses). Compared to non-OSGM, OSGM adults have higher rates of medical visits (adjusted rate ratio [aRR]: 1.14; 95% CI: 1.03, 1.24) and MH visits (aRR: 1.85; 95% CI: 1.07, 2.91). Frailty mediated the association between OSGM status medical visits (Controlled direct effect [Rcde] aRR: 1.03, 95% CI [0.87, 1.22]), but not MH visits (Rcde aRR: 0.37 [95% CI: 0.06, 1.47]). Delays mediated the association between OSGM status and MH visit days (Rcde aRR: 2.27, 95% CI [1.15, 3.76]), but not medical visits (Rcde aRR: 1.06 [95% CI: 0.97, 1.17]). Frailty represents a need for medical care among OSGM adults, highlighting the importance of addressing it to improve health and healthcare utilization disparities. In contrast, healthcare delays are a barrier to MH care, underscoring the necessity of targeted strategies to ensure timely MH care for OSGM adults.

Factors influencing compliance with multiple injection immunization among mothers of toddlers at The Public Health Center Porong Integrated Health Service Post, Sidoarjo, East Java, Indonesia: A Descriptive Study

Introduction: Immunization significantly reduces infant and child morbidity and mortality rates globally. However, basic immunization coverage in 65 countries must catch up to the 90% global target. Multiple injection immunization involves administering multiple immunizations in one visit, enhancing early protection during vulnerable periods. This approach reduces the need for multiple health visits, which is particularly beneficial for children facing access barriers. It also improves healthcare efficiency, minimizes missed opportunities, and lessens the burden on parents needing frequent facility visits. Objective: The objective of this study was to explore the factors influencing compliance with multiple injection immunization among mothers of toddlers at the Public Health Center Porong Integrated Health Service Post, Sidoarjo, East Java, Indonesia Method: Conducted in March 2024 at Public Health Centre Porong, Indonesia, this study employed a consecutive sampling method. It involved 100 mothers with infants aged 13 to 24 months who had received immunizations at the Post. Data were collected through structured interviews and analyzed to determine compliance rates and associated factors. Result: Among the participants, 91% of mothers were aged between 20 to 35 years, indicating a productive age group. The compliance rate for multiple injection immunization was 61%. Additionally, 74% of mothers had completed high school, suggesting a positive association between higher education and enhanced health decision-making capabilities. A significant proportion of mothers (75%) were not employed, highlighting the influence of occupation on health-related knowledge and practices. Conclusion: The study underscores the necessity for targeted health education initiatives tailored to the diverse demographic and occupational characteristics of mothers. Such interventions should improve maternal knowledge and promote adherence to essential childhood immunizations, leveraging the cognitive advantages associated with higher education and non-working status. This approach aims to foster informed decision-making and proactive health behaviours among mothers in community health settings.

Uncovering the reasons behind irregular visits by patients with type 2 diabetes mellitus

Background: Type 2 diabetes mellitus (DM) is a non-communicable disease with an increasing incidence. DM is associated with deaths caused by several complications. One of the efforts to manage DM is to control blood glucose by maintaining regular check-ups and treatment compliance. Unfortunately, many people with DM still need to visit health facilities regularly.Purpose: This study aimed to explain the factors associated with the irregularity of type 2 DM patients having check-ups at the public health center (puskesmas).Methods: This cross-sectional study used the medical record data from Grabag II Public Health Center. The subjects were 135 outpatients with type 2 DM and complete medical records.Results: The results showed that visit irregularity was significantly associated with sex (OR = 3.8; 95% CI = 1.12-12.79), distance from home (OR = 0.2; 95% CI = 0.06-0.52), and duration of diagnosis (OR = 0.3; 95% CI= 0.12-0.85), but not with age, insurance, comorbidities, and types of therapy.Conclusion: Factors associated with type 2 diabetes mellitus patients' irregular visits to Puskesmas are sex, distance from home, and duration of diagnosis. Educational interventions at all levels of society should be carried out to increase knowledge about DM and the importance of regular check-ups and medication

How, when and who should ask about pregnancy intentions in primary care? A qualitative study of primary health care professionals' preferences.

Knowing people's pregnancy intentions would help health care professionals (HCPs) to take a holistic approach to reproductive health, and particularly to providing preconception care. To assess the feasibility of implementation of questions about pregnancy preferences in a range of primary care settings in Great Britain, including digital implementation. Qualitative study using online semi-structured interviews with primary care professionals across Great Britain in 2022. Twelve online interviews were conducted with GPs (n=3), practice nurses (n=3), sexual and reproductive health professionals (n=4) and health visitors (n=2). Framework analysis was conducted in Nvivo, adapting a coding frame from complementary interviews with women. HCPs perceived asking about pregnancy preferences as valuable in meeting patients' reproductive health needs and most suited to women's health consultations, medication and disease reviews, baby checks, or as an addition to lifestyle questions leading to health promotion advice. An introductory, non-discriminatory signposting sentence was well-liked, and the preferred question in a face-to-face clinical encounter was asking how the person would feel about a pregnancy in the next year, in line with women's preference. Guidance and training would give clinicians confidence in knowing how to ask about pregnancy preferences and advise their patients accordingly. Asking about pregnancy intentions is acceptable to women and HCPs and feasible in primary care, but implementation needs to be adapted to the patient and context. Digital options that enable patients to self-manage can reduce the need for HCP input and avoid medicalising a normal process.

Home health utilization in the Veterans Health Administration: Are there rural and urban differences?

Growing numbers of older adults need home health care, yhese services may be more difficult to access for rural Veterans, who represent one-third of Veterans Health Administration (VA) enrollees. Our objective was to examine whether home health use differs within VA based on rurality. We examined national VA administrative data for 2019-2021 (January 1, 2019 to December 31, 2021) among Veterans ages ≥65 years. Using descriptive and multivariable analyses, we assessed whether rural versus urban Veterans differed in (1) the likelihood of using any home health and (2) for those who received ≥1 visit, number of visits received. Among home health users (n = 107,229, 33.1% rural), rural and urban Veterans were similar in age (77.0vs. 77.2 years). Rural Veterans were less likely to be highly frail (38.9% rural vs. 40.4% urban) or diagnosed with dementia (13.5%vs. 17.6%). After adjusting for Veterans' characteristics, rural Veterans were more likely to receive any home health (odds ratio: 1.10; 95% confidence interval [CI]: 1.07, 1.13). Among Veterans who received ≥1 home health visit, rurality was associated with considerably fewer expected visits (incident rate ratio: 0.70; 95% CI: 0.68, 0.72). Although rural Veterans were more likely than urban Veterans to receive any home health services, they received considerably fewer home health visits. This difference may represent an access issue for rural Veterans. Future research is needed to identify reasons for these differences and develop strategies to ensure rural Veterans' care needs are equitability addressed.

The Medicare annual wellness visit: An opportunity to improve health system identification of hearing loss?

Hearing loss is prevalent and consequential but under-diagnosed and managed. The Medicare Annual Wellness Visit (AWV) health risk assessment elicits patient-reported hearing concerns but whether such information affects documentation, diagnosis, or referral is unknown. We use 5 years of electronic medical record (EMR) data (2017-2022) for a sample of 13,776 older primary care patients. We identify the first (index) AWV indication of hearing concerns and existing and subsequent hearing loss EMR diagnoses (visit diagnoses or problem list diagnoses) and audiology referrals. For a 20% random sample of AWV notes (n = 474) we compared hearing loss EMR diagnoses to documentation of (1) hearing concerns, (2) hearing loss/aid use, and (3) referrals for hearing care. Of 3845 (27.9%) older adults who identified hearing concerns (mean age 79.1 years, 57% female, 75% white) 24% had an existing hearing diagnosis recorded. Among 474 patients with AWV clinical notes reviewed, 90 (19%) had an existing hearing loss diagnosis. Clinicians were more likely to document hearing concerns or hearing loss/aid use for those with (vs. without) an existing EMR diagnosis (50.6% vs. 35.9%, p = 0.01; 68.9% vs. 37.5%, p < 0.001, respectively). EMR diagnoses of hearing loss were recorded for no more than 40% of those with indicated hearing concerns. Among those without prior diagnosis 38 (9.9%) received a hearing care referral within 1 month. Subgroup analysis suggest greater likelihood of documenting hearing concerns for patients age 80+ (OR:1.51, 95% confidence interval [CI]: 1.03, 2.19) and decreased likelihood of documenting known hearing loss among patients with more chronic conditions (OR: 0.49, 95% CI: 0.27, 0.9), with no differences observed by race. Documentation of hearing loss in EMR and AWV clinical notes is limited among older adults with subjective hearing concerns. Systematic support and incorporation of hearing into EMR and clinical notes may increase hearing loss visibility by care teams.

Monitoring what matters to people with diabetes: Do we underestimate the importance of behaviour, attitude, and well-being?

ObjectiveDespite improvements in diabetes monitoring and treatment many patients do not achieve treatment goals. Person-centred approaches have been proposed. However, their practical implementation lags. One barrier is uncertainty about which person-reported outcomes (PROs) should be considered to add the most value. We sought to identify PROs that may be prioritised. MethodsWe used data from a multi-stakeholder Delphi study aimed at developing a person-centred diabetes outcome set and analysed which PROs patients considered important for regular monitoring but healthcare providers less so. Linear regression analyses tested whether belonging to either stakeholder group would predict the importance attributed to an outcome. ResultsWe found disagreement between patients and healthcare providers on eleven PROs. Stakeholder group predicted perceived importance for ten: self-management behaviours (including performance, perceived importance, motivation, and capacity), sleep quality, diabetes symptoms, screening visit attendance, health status, lifestyle behaviours, and side effects. ConclusionOur findings suggest that, according to patients’ preferences, self-management behaviours, health status and sleep are currently not adequately considered in diabetes management, compromising person-centred care. Practical implicationsThis study suggests that prioritising these PROs can facilitate the implementation of more person-centred diabetes monitoring which may support better-informed treatment decisions to achieve treatment goals.

Determinants of wealth-related inequalities in full vaccination coverage among children in Nepal: a decomposition analysis of nationally representative household survey data

BackgroundOver the past two decades, child health indicators in Nepal have improved significantly at the national level. Yet, this progress hasn’t been uniform across various population subsets. This study identified the determinants associated with childhood full vaccination, assessed wealth-related inequalities, and delved into the key factors driving this inequality.MethodsData for this study were taken from the most recent nationally representative Nepal Demographic and Health Survey 2022. A total of 959 children aged 12–23 months who had received routine childhood basic antigens as per the national immunisation program were considered for analysis. Binary logistic regression models were conducted to identify the associated factors with outcome variable (uptake of full vaccination). The concentration curve and Erreygers normalized concentration index were used to assess inequality in full vaccination. Household wealth quintile index scores were used to measure wealth-related inequality and decomposition analysis was conducted to identify determinants explaining wealth-related inequality in the uptake of childhood vaccination.ResultsThe coverage of full vaccination among children was 79.8% at national level. Several factors, including maternal health service utilisation variables (e.g., antenatal care, institutional delivery), financial challenges related to visiting health facilities, and mothers’ awareness of health mother group meetings within their ward, were associated with the uptake of full vaccination coverage among children. The concentration curve was below the line of equality, and the relative Erreygers normalized concentration index was 0.090, indicating that full vaccination was disproportionately higher among children from wealthy groups. The decomposition analysis identified institutional delivery (20.21%), the money needed to visit health facilities (14.25%), maternal education (16.79%), maternal age (8.53%), and caste (3.03%) were important contributors to wealth related inequalities in childhood full vaccination uptake.ConclusionsThere was notable wealth-related inequality in full vaccine uptake among children in Nepal. Multisectoral actions involving responsible stakeholders are pivotal in reducing the inequalities, including promoting access to maternal health services and improving educational attainment among mothers from socioeconomically disadvantaged communities.

Navigating the integration of knowledge and research evidence in clinical practice for children's foot health: A multi-professional survey.

Access to clinical services for children with foot and ankle problems are important, but unravelling the complexity of practice and service delivery can be challenging. The pursuit and implementation of research evidence is critical for driving positive change in practice, but little is understood about the approaches to knowledge and research acquisition in children foot health. The aim of the study was to: (1) explore multi-professional habits of knowledge and research evidence acquisition in children's foot health; and (2) understand how clinicians integrate information for children and their families into their practice. This was a descriptive, cross-sectional online survey. Participants were included if they worked in the UK and had experience of working within paediatric services. There were complete responses from 247 health professionals, representing physiotherapists (n=160), podiatrists (n=50), orthotists (n=25), nurses and specialists in community public health nurses (health visitors) (n=12). Three main themes were generated from the data: (1) Factors that influence knowledge and inform clinical practice. (2) The role of Professional Bodies in informing professional knowledge. (3) Health Professionals' views on managing health information for parents and caregivers. This work advances understanding of the value health professionals' place in the development of materials for informing professional knowledge, as well as highlighting some of the challenges with translation of knowledge into clinical practice. The findings offer a national perspective of health professionals working on children's foot health and have highlighted that some of the most valued influences on clinical practice come from peer-to-peer networking.

Time to recovery and its predictors among under-five children admitted with severe pneumonia in East Wallaga Zone public hospitals, western Ethiopia, 2023; a retrospective cohort study

BackgroundGlobally, pneumonia is one of the leading causes of morbidity and mortality as well as hospitalization burden for under-five children. Despite significant initiatives implemented to reduce morbidity and mortality from pneumonia in under-five children, little is known regarding the time to recovery and its predictors among under-five children admitted with severe pneumonia in Ethiopia. Hence, this study intended to estimate the median time to recovery and its predictors among under-five children admitted with severe pneumonia in East Wallaga zone public hospitals, western Ethiopia; 2023.MethodsAn institution-based retrospective cohort study was conducted among 383 under-five children who were admitted with severe pneumonia in East Wallaga zone public hospitals from January 2017 to December 2022. A systematic sampling method was used to select eligible medical records. EpiData Version 4.6 was used to enter the data and analyzed using STATA Version 17.0. Cox-proportional hazard assumption test and model fitness were checked. Variables with P-value ˂ 0.25 at bivariable Cox regression analysis were selected for the multivariable Cox proportional model. A multivariable Cox regression model with 95% CI and Adjusted Hazard Ratio (AHR) was used to identify a significant predictor of time to recovery from severe pneumonia at a P-value < 0.05.ResultsAt the end of the follow-up, 356 observations were developed an event (recovered) with the median time to recovery of 4 days with IQR of 3–5 days. The overall incidence rate of recovery was 22.26 per 100 (95% CI: 20.07–24.70) person-days observations. Being rural residency (AHR: 0.75, 95% CI: 0.60–0.93), late presenters for seeking care (AHR = 0.70, 95% CI: 0.53–0.93), presence of danger sign at admission (AHR = 1.46, 95% CI: 1.15–1.83), and presence of comorbidity (AHR = 1.63, 95% CI, 1.31–2.04) were found to have a statistically significant association with prolonged recovery time.ConclusionThe median time to recovery from severe pneumonia was long, and factors such as Residence, co-morbidity, presence of danger signs, and duration prior to seeking care were statistically significant predictors of recovery time from severe pneumonia. Hence, due attention has to be given to increasing the community’s health-seeking behavior to visit health facility early and especial attention should be given for children with danger signs and comorbidity.

A tool to assess early motor skill development: A study of Danish health visitors’ practice

In Denmark, health visitors play a crucial role in identifying early motor skill difficulties. In 74 % of the Danish municipalities, they use a motor skill assessment tool for infants aged 9–11 months, consisting of evaluating nine motor milestones. The assessment results in one of three remarks: 'age-appropriate motor development', ‘heightened attention required', or 'intervention needed'. This article aims to: 1) determine the relative importance of each milestone in the overall assessment score, 2) investigate the consistencies in test usage across municipalities, and 3) explore factors influencing health visitors' assessments. This mixed methods study utilizes questionnaires and interviews with health visitors from two municipalities. Findings indicate a general consistency in the importance of each motor milestone in both municipalities, with the exception of the milestone 'chews food with a coarser consistency and takes an interest in eating by him/herself.' The health visitors also consider the achievement of the nine-motor milestones more important as the child gets older. Health visitors in both municipalities follow a uniform approach, emphasizing continuous child development over specific motor milestone achievement. They also consider factors like interaction, sensory perception, overall and social development, and the joy of movement, which are not part of the formal assessment. This illustrates that the health visitors have a dynamic system approach to testing motor development, broadening the motor assessment beyond the tool's milestones.

Mental health care use and quality among Medicaid adults with serious mental illness receiving care at Federally Qualified Health Centers vs. other settings

BackgroundFederally Qualified Health Centers (FQHCs) are a critical source of care for medically underserved populations and often serve as medical homes for individuals with serious mental illness (SMI). Many FQHCs provide mental health services and could facilitate access to mental health treatment within and outside of FQHCs. This study compared mental health care utilization and acute care events for adult Medicaid enrollees with SMI who receive care at Federally Qualified Health Centers (FQHCs) vs. other settings.MethodsThis study used the 2015–2016 Massachusetts All-Payer Claims Database to examine outpatient mental health care and acute care events for 32,330 Medicaid adults, ages 18–64 and with major depressive, bipolar, or schizophrenia spectrum disorders (SSD), who resided in FQHC service areas and received care from FQHCs vs. other settings in 2015. Multivariable linear regressions assessed associations between receiving care at FQHCs and outpatient mental health visits, psychotropic medication fills, and acute care events in 2016.ResultsThere were 8,887 (27.5%) adults in the study population (N = 32,330) who had at least one FQHC visit in 2015. Those who received care at FQHCs were more likely to have outpatient mental health visits (73.3% vs. 71.2%) and psychotropic medication fills (73.2% vs. 69.0%, both p < .05), including antidepressants among those with depressive disorders and antipsychotics among those with SSD. They were more likely to have ED visits (74.0% vs. 68.7%), but less likely to be hospitalized (27.8% vs. 31.9%, both p < .05). However, there was no significant difference in the likelihood of having an acute psychiatric hospitalization (9.5% vs. 9.8%, p = .35).ConclusionsAmong Medicaid enrollees with SMIs who had access to care at FQHCs, those receiving care at FQHCs were more likely to have outpatient mental health visits and psychotropic medication fills, with lower rates of hospitalization, suggesting potentially improved quality of outpatient care. Higher ED visit rates among those receiving care at FQHCs warrant additional investigation.

Facilitators and Barriers to Shared Decision-Making Communication Between Latina Mothers and Pediatric Mental Healthcare Providers

ABSTRACT This study assessed communication factors influencing shared decision-making (SDM) between language-congruent clinicians and Latina mothers of pediatric mental health patients. The sample comprised Latinx youth up to 22 years old who were enrolled in mental healthcare and attended mental health-related sessions with their parent. One hundred transcripts depicting mental health visits were coded using the Conversation Analysis framework. Coding included inductive coding that came from analyzing the structure, or orderliness, of the visits and content discussed that affects SDM. Thematic qualitative analysis revealed that facilitators to SDM included collaborative engagement, parents being active in tailoring session content, and integrating the preferences, roles, and next steps for treatment among all participants. Barriers included unskilled interpersonal interactions undermining rapport, off-topic conversations becoming the session’s focus, poor time management, and irregularly integrating parent/patient preferences into the clinician’s decisions regarding the child’s treatment. Additionally, visit content, structure, tone, and interpersonal engagement were factors that variably facilitated or served as barriers to patient participation in SDM and were integral to collaborative, family-centered care. These findings delineated characteristics of pediatric mental health conversations and identified areas to strengthen communication between parents, patients, and clinicians to shift toward more effective SDM and improve patient outcomes among Latinx families.

Predeductible Coverage and Receipt of Telemental Health Visits

This cohort study examines the utilization changes associated with the reintroduction of cost sharing for patients receiving telemental health services.