Racial and Ethnic Inequities in Use of Preventive Services Among Privately Insured Adults With a Pediatric-Onset Disability.

PURPOSE: Cerebral palsy (CP) and spina bifida (SB) are pediatric-onset disabilities. Adults living with CP/SB are in a greater need of preventive care than the general population due to their increased risk for chronic diseases. Our objective was to compare White/Black and White/Hispanic inequities in the use of preventive services. METHODS: Using 2007-2017 private claims data, we identified a total of 11,635 adults with CP/BS. Of these, 8,935 were White, 1,457 Black, and 1,243 Hispanic. We matched health-related variables (age, sex, comorbid conditions) between White adults and those in each minority subpopulation. Generalized estimating equations were used and all models were adjusted for age, sex, comorbidities, income, education, and US Census divisions. Outcomes of interest were: (1) any office visit; (2) any physical/occupational therapy; (3) wellness visit; (4) bone density screening; (5) cholesterol screening; and (6) diabetes screening. RESULTS: The rate of recommended services for all subpopulations of adults with CP/SB was low. Compared with White adults, Hispanic adults had lower odds of wellness visits (odds ratio [OR] = 0.71, 95% CI, 0.53-0.96) but higher odds of diabetes screening (OR = 1.48, 95% CI, 1.13-1.93). Compared with White adults, Black adults had lower odds of wellness visits (OR = 0.50, 95% CI, 0.24-1.00) and bone density screening (OR = 0.54, 95% CI, 0.31-0.95). CONCLUSIONS: Preventive service use among adults with CP/SB was low. Large White-minority disparities in wellness visits were observed. Interventions to address physical accessibility, adoption of telehealth, and increased clinician education may mitigate these disparities, particularly if initiatives target minority populations.

Group Prenatal Visits: Maternal and Neonatal Health Outcomes.

INTRODUCTION: Most studies evaluating the effect of group prenatal care on maternal and neonatal health outcomes assess the CenteringPregnancy model, which follows a set structure and educational curriculum. Group prenatal visits (GPVs) bring together pregnant patients for visits that include education and a health evaluation. GPVs represent a more flexible method of delivering group prenatal care, compared with CenteringPregnancy. Our study sought to determine whether GPV participation affects maternal and neonatal health outcomes. METHODS: The Myers Park Obstetrics and Gynecology Clinic is located in Charlotte, North Carolina, and serves a racially, ethnically, and socioeconomically diverse population. GPVs were offered at the clinic between July 2014 and July 2015. Retrospective data were collected for women who obtained prenatal care, either GPV or individual care, during that period. Demographic, birth, and postpartum data were extracted from the electronic health record. GPV participants were categorized by the percent of prenatal visits that were GPVs (limited GPV: <30% of visits as GPV; moderate GPV: ≥30% of visits as GPV). Logistic regression models were created to assess the effect of GPV participation on low birth weight, preterm birth, cesarean birth, and postpartum visit attendance. RESULTS: There were 355 study participants (GPV n = 78, individual care n = 277). Among GPV participants, 52.6% were classified as limited GPV, and 47.4% were classified as moderate GPV. The adjusted analysis showed limited-GPV patients had lower odds of postpartum visit attendance, compared with individual-care patients (odds ratio, 0.48; 95% CI, 0.24-0.94). Neither the unadjusted nor adjusted models demonstrated a statistically significant association between GPV participation and low birth weight, preterm birth, or cesarean birth. DISCUSSION: GPVs for prenatal care can be implemented without negative effects on maternal or neonatal health. However, fidelity to a more comprehensive model of group prenatal care may be necessary to achieve health outcome improvements.

Source of care and variation in long-acting reversible contraception use.

OBJECTIVE: To examine variation in long acting reversible contraception (LARC) use by source of birth control services. DESIGN: Cross-sectional study. SETTING: Not applicable. PATIENT(S): Sexually active women who received contraceptive services in the past 12 months, who were neither pregnant nor trying to become pregnant and who were not sterilized and nor were their partners sterilized. INTERVENTION(S): Three multinomial logistic regression models assessed the relationship between source of services and LARC use, controlling for covariates. The odds of LARC use were compared with LARC nonuse, high-efficacy use, and low-efficacy use. MAIN OUTCOME MEASURE(S): Reported LARC method use. RESULT(S): There was no statistically significant difference in LARC use between women receiving services from community or public health clinics and women receiving services from private clinics. Women receiving care at a family-planning clinics had lower odds of LARC use versus LARC nonuse (odds ratio [OR] = 0.27; 95% confidence interval [CI], 0.10-0.74), versus high-efficacy method use (OR = 0.32; 95% CI, 0.11-0.88) and versus low-efficacy method use (OR = 0.13; 95% CI, 0.02-0.87) compared with those receiving services at private clinics. CONCLUSION(S): Women receiving care from family-planning clinics had lower odds of LARC use compared with those receiving care from a private doctor's office or health maintenance organization facility.

Promising Approaches From Behavioral Economics to Improve Patient Lung Cancer Screening Decisions.

Lung cancer is a devastating disease, the deadliest form of cancer in the world and in the United States. As a consequence of CMS's determination to provide low-dose CT (LDCT) as a covered service for at-risk smokers, LDCT lung cancer screening is now a covered service for many at-risk patients that first requires counseling and shared clinical decision making, including discussions of the risks and benefits of LDCT screening. However, shared decision making fundamentally relies on the premise that with better information, patients will arrive at rational decisions that align with their preferences and values. Evidence from the field of behavioral economics offers many contrary viewpoints that take into account patient decision making biases and the role of the shared decision environment that can lead to flawed choices and that are particularly relevant to lung cancer screening and treatment. This article discusses some of the most relevant biases, and suggests incorporating such knowledge into screening and treatment guidelines and shared decision making best practices to increase the likelihood that such efforts will produce their desired objectives to improve survival and quality of life.