Pregnancy and Childbirth Expectations During COVID-19 in a Convenience Sample of Women in the United States

The COVID-19 pandemic has transformed the health care landscape and shifted individuals’ expectations for and interactions with essential health services, including pregnancy-related care. This study explores alterations to individuals’ pregnancy and childbirth decisions during an infectious disease pandemic. A convenience sample of 380 pregnant individuals with an expected delivery date between April and December 2020 consented to enroll and complete an online questionnaire on their pregnancy and childbirth expectations during the COVID-19 pandemic; a subset of respondents (n = 18) participated in semi-structured phone interviews. Survey data were analyzed quantitatively while interview data were analyzed using a thematic content analysis until a consensus on key themes was achieved. Respondents reported substantial stressors related to shifting policies of health care facilities and rapidly changing information about COVID-19 disease risks. As a result, respondents considered modifying their prenatal and childbirth plans, including the location of their birth (25%), health care provider (19%), and delivery mode (13%). These findings illuminate the concerns and choices pregnant individuals face during the COVID-19 pandemic and offer recommendations to engage in compassionate, supportive, and person-centered care during a time of unprecedented risk and uncertainty

Quality and Cost of Diabetes Mellitus Care in Community Health Centers in the United States

Objective To examine variations in the quality and cost of care provided to patients with diabetes mellitus by Community Health Centers (CHCs) compared to other primary care settings. Research Design and Methods We used data from the 2005–2008 Medical Expenditure Panel Survey (N = 2,108). We used two dependent variables: quality of care and ambulatory care expenditures. Our primary independent variable was whether the respondent received care in a Community Health Centers (CHCs) or not. We estimated logistic regression models to determine the probability of quality of care, and used generalized linear models with log link and gamma distribution to predict expenditures for CHC users compared to non-users of CHCs, conditional on patients with positive expenditures. Results Results showed that variations of quality between CHC users and non-CHC users were not statistically significant. Patients with diabetes mellitus who used CHCs saved payers and individuals approximately $1,656 in ambulatory care costs compared to non-users of CHCs. Conclusions These findings suggest an opportunity for policymakers to control costs for diabetes mellitus patients without having a negative impact on quality of care

Scheduling Recess Before Lunch: Perceptions of Washington State Public Elementary School Professionals

Recess Before Lunch (RBL) is a wellness strategy with a purpose of improving the overall health and behavior of school-aged children. While some studies have reported a variety of benefits and challenges by simply scheduling recess prior to the specified lunchtime, few have examined adequate strategies for successful implementation. This mixed-methods study asked elementary school principals and school food service directors within each K-5th grade public school throughout the state of Washington to participate in an online survey assessing their school’s experience using RBL. Schools were placed into three groups based on participants’ stage of RBL adoption: (1) currently using RBL, (2) previously used RBL, or (3) have never implemented RBL. Basic demographic information from each school was collected and matched to the survey responses. Participants from the online survey were asked to provide contact information of a school professional closely involved with the lunch services in their school to complete a semi-structured follow-up interview. Eighteen individuals, six in each of the three stages of RBL adoption, participated in a 10-15-minute phone interview to further investigate perceptions related to RBL. Roughly 75.8% of schools reported having some experience with RBL (N = 74). Benefits most often reported were associated with Nutrition & Food Waste, Behavior & Disruption and Scheduling, respectively; whereas the barriers included Scheduling & Staffing, Logistics, Nutrition & Food Waste and Behavior & Disruption, respectively. However, whether a school reported any benefits had no effect on its history of scheduling the program. A significant correlation was found between student enrollment and a school’s experience with RBL. Schools that never implemented RBL had smaller student enrollments (p \u3c 0.01) and were significantly more likely to report any barriers (p \u3c 0.01), whereas schools currently utilizing the program that had a higher student enrollment (p \u3c 0.05) when compared to all other schools. Telephone interviewees reported the significance of gaining support from all involved parties and encouraged finding solutions to challenges prior to implementing the program

A Natural Fit: Collaborations Between Community Health Centers and Family Planning Clinics

Federally Qualified Health Centers (FQHCs) and family planning clinics funded through Title X of the Public Health Service Act are critical components of the health care safety net in urban and rural medically underserved communities. Although they share the common mission of serving vulnerable and low-income populations, health centers and Title X clinics possess different, but complementary, strengths. The Patient Protection and Affordable Care Act (Affordable Care Act) will expand coverage to an additional 32 million people while leaving 23 million uninsured. Most of the newly insured and the remaining uninsured will be residents of medically-underserved communities, and thus, positioning the safety net to meet demand will be highly important

Patient perspectives on quality family planning services in underserved areas

Ongoing challenges impede efforts to improve the quality of family planning services in underserved communities, which by definition lack sufficient numbers of physicians and other health professionals. Challenges to improving the quality of family planning services include financing difficulties, lack of standards, training deficiencies, as well as little understanding and attention to patient preferences. The objectives of this study were to explore female patients’ preferences for family planning services in underserved areas and to develop a framework to help providers improve patient-centered care. The methodology for this paper included mixed methods research including a survey of women between the ages of 18 and 44 in 19 underserved communities (n=1868) across the United States and qualitative research involving 16 focus groups (n=103) to explore patient preferences and experiences with family planning services. Descriptive statistics of survey items and thematic analysis of transcripts were utilized to analyze study data. Triangulation of data sources and methods resulted in an overall framework for patient-centered family planning care. The results show women in underserved areas identified important aspects of family planning care as: relationship with provider, communication, confidentiality in receiving care, provider competence, service access and convenience. The conclusion suggests improving patient-centered care for family planning services could improve outcomes by increasing patient return for follow up care, patient pursuit of other primary and preventive care services, continuation rates of contraceptive method, and higher contraceptive use. Achieving patient-centered family planning care will require investments in human capital and technology, modifications in clinic operations, and an organizational culture focused on patient preferences and experience

Patient Experiences With Family Planning in Community Health Centers

Women of childbearing age represent one of the single largest groups of community health center patients, and family planning plays a critical role in the health, economic, and social circumstances of women, their children, and families. Family planning is a required service at all health centers, and the major expansion of health centers under the Affordable Care Act means that for low-income women of reproductive age this service should be increasingly available. The Quality Family Planning (QFP) Guidelines, jointly developed by the Centers for Disease Control and Prevention (CDC) and the Office of Population Affairs (OPA) and released in 2014, provide a new opportunity to strengthen family planning service delivery for all patients of reproductive age.1 But limited and somewhat dated information exists regarding both patients’ experiences receiving primary care at health centers generally, and women’s experiences with family planning care at health centers specifically. 2 , 3 With patient-centeredness playing an increasingly central role in quality improvement efforts, information regarding the importance placed on family planning services by patients and their experiences receiving care becomes ke

Community Health Centers’ Response to Family Planning Needs in the Era of Health Reform

BACKGROUND Community health centers represent the nation’s largest delivery system for low-income individuals and families, including six million women of reproductive age. However, the changing landscape of health policy over the last several years has made health centers’ capacity to respond to women’s health needs unclear. This study aims to explore the challenges, barriers, opportunities, and successful models of family planning service delivery in health center settings in the context of rapidly shifting state and federal policy. METHODS Using a comparative case study approach, we conducted in-depth site visits at four community health centers from distinct geographic regions in different policy climates. We conducted semi-structured interviews with clinical, administrative, and executive staff members. Two investigators conducted thematic content analysis of interview transcripts until consensus on key themes emerged. RESULTS Within-case and cross-case themes encompass: perceptions of and responses to community-based reproductive health needs; models of family planning care; and the impact of federal and state policies on health center operations. Staff at all health centers described patient preferences as influencing the scope of family planning services and supplies available at their health centers. Although all health centers provided some level of family planning care, staffing patterns differed; some sites created a family planning team or employed dedicated reproductive healthcare staff, while others incorporated family planning into the same processes as their general primary care practice. Some health center staff considered family planning a portal of entry into primary care, while others perceived primary care as an entry point for family planning. All health centers described challenges related to uncertainty and instability in state and federal policy, including the Affordable Care Act, and a need for flexibility in response to continuing policy changes. Finally, leadership staff who are invested in family planning and see its value serve as a facilitator for high performance and as a key component of a health center’s ability to navigate the current policy climate. IMPLICATIONS Community health centers provide essential health services for women of reproductive age. This study identifies commonalities and differences in health centers’ approaches to family planning in a time of policy uncertainty. It also identifies barriers to and facilitators of providing family planning care that is responsive to community needs. As federal and state policies continue to shift, the findings from this study provide emerging models of care and best practices that can be implemented in health centers around the country