Patient characteristics in 2015 by pediatric specialty visit attendance during 2016–2019 (N = 852 patients).

Patient characteristics in 2015 by pediatric specialty visit attendance during 2016–2019 (N = 852 patients).</p

Deidentified final dataset.

Following the 2016 US Presidential election, immigration enforcement became more aggressive, with variation by state and region depending on local policies and sentiment. Increases in enforcement created an environment of risk for decreased use of health care services among especially among Latino families. of Hispanic ethnicity and/or from Latin American origin (as a group subsequently referred to as Latino). For Latino children with chronic health conditions, avoidance of routine health care can result in significant negative health consequences such as disease progression, avoidable use of acute health care services, and overall increased costs of care. To investigate for changes in visit attendance during the periods before and since increased immigration enforcement, we extracted data on children followed by subspecialty clinics of one healthcare system in the US state of North Carolina during 2015–2019. For each patient, we calculated the proportion of cancelled visits and no-show visits out of all scheduled visits during the 2016–2019 follow-up period. We compared patient characteristics (at the 2015 baseline) according to whether they cancelled or did not show to any visits in subsequent years by clinic and patient factors, including ethnicity. Data were analyzed using multinomial logistic regression of attendance at each visit, including an interaction between visit year and patient ethnicity. Among 852 children 1 to 17 years of age (111 of Latino ethnicity), visit no-show was more common among Latino patients, compared to non-Latino White patients; while visit cancellation was more common among non-Latino White patients, compared to Latino patients. There was no significant interaction between ethnicity and trends in visit no-show or cancellation. Although differences in pediatric specialty clinic visit attendance by patient ethnicity were seen at study baseline, changing immigration policy and negative rhetoric did not appear to impact use of pediatric subspecialty care.</div

Code for replicating analyses based on deidentified final dataset.

Code for replicating analyses based on deidentified final dataset.</p

Multivariable multinomial logistic regression of pediatric specialty clinic visit outcome during 2016–2019, interacting visit year and race/ethnicity (N = 9,346 visits).

Multivariable multinomial logistic regression of pediatric specialty clinic visit outcome during 2016–2019, interacting visit year and race/ethnicity (N = 9,346 visits).</p

Predicted probabilities of visit cancellation and visit no-show at pediatric specialty clinics, by year and race/ethnicity, based on multivariable multinomial regression with all covariates held constant at their means.

Predicted probabilities of visit cancellation and visit no-show at pediatric specialty clinics, by year and race/ethnicity, based on multivariable multinomial regression with all covariates held constant at their means.</p

Multivariable multinomial logistic regression of pediatric specialty clinic visit outcome during 2016–2019 (N = 9,346 visits).

Multivariable multinomial logistic regression of pediatric specialty clinic visit outcome during 2016–2019 (N = 9,346 visits).</p

Conceptual framework for classification of antidepressant treatment decisions.

<p>Conceptual framework for classification of antidepressant treatment decisions.</p

The depression treatment continuum for patients engaged in HIV primary care.

<p>The depression treatment continuum for patients engaged in HIV primary care.</p

Description of sample.

<p>Description of sample.</p

Antidepressant treatment, treatment adjustments, and remission.

<p>Antidepressant treatment, treatment adjustments, and remission.</p