Prenatal opioid use as a predictor of postpartum suicide attempts among reproductive-age women enrolled in Oregon Medicaid.

BACKGROUND: The rates of suicide and opioid use disorder (OUD) among pregnant and postpartum women continue to increase. This research characterized OUD and suicide attempts among Medicaid-enrolled perinatal women and examined prenatal OUD diagnosis as a marker for postpartum suicide attempts. METHODS: Data from Oregon birth certificates, Medicaid eligibility and claims files, and hospital discharge records were linked and analyzed. The sample included Oregon Medicaid women aged 15-44 who became pregnant and gave live births between January 2008 and January 2016 (N = 61,481). Key measures included indicators of suicide attempts (separately for any means and opioid poisoning) and OUD diagnosis, separately assessed during pregnancy and the one-year postpartum period. Probit regression was used to examine the overall relationship between prenatal OUD diagnosis and postpartum suicide attempts. A simultaneous equations model was employed to explore the link between prenatal OUD diagnosis and postpartum suicide attempts, mediated by postpartum OUD diagnosis. RESULTS: Thirty-three prenatal suicide attempts by any means were identified. Postpartum suicide attempts were more frequent with 58 attempts, corresponding to a rate of 94.3 attempts per 100,000. Of these attempts, 79% (46 attempts) involved opioid poisoning. A total of 1,799 unique women (4.6% of the sample) were diagnosed with OUD either during pregnancy or one-year postpartum with 53% receiving the diagnosis postpartum. Postpartum suicide attempts by opioid poisoning increased from 55.5 per 100,000 in 2009 to 105.1 per 100,000 in 2016. The rate of prenatal OUD also almost doubled over the same period. Prenatal OUD diagnosis was associated with a 0.15%-point increase in the probability of suicide attempts by opioid poisoning within the first year postpartum. This increase reflects a three-fold increase compared to the rate for women without a prenatal OUD diagnosis. A prenatal OUD diagnosis was significantly associated with an elevated risk of postpartum suicide attempts by opioid poisoning via a postpartum OUD diagnosis. CONCLUSIONS: The risk of suicide attempt by opioid poisoning is elevated for Medicaid-enrolled reproductive-age women during pregnancy and postpartum. Women diagnosed with prenatal OUD may face an increased risk of postpartum suicides attempts involving opioid poisoning.

Validation of a Modified Group-Based Medical Mistrust Scale Among Young Latinx Adults in the United States.

Medical mistrust is an important barrier to accessing health care among Latinx populations in the United States (US). However, research on the validity and reliability of medical mistrust scales is limited. We examined the validity and reliability of a modified bilingual version of the Group-Based Medical Mistrust scale (mGBMMS) among a sample of Latinx adults. Participants included 308 Latinx adults (ages 18-25), who responded in Spanish (n = 134) or English (n = 174). Following feedback from bilingual/bicultural staff during the English-Spanish translation process, we made three changes to the original GBMMS. Validation testing of our 12-item mGBMMS scale included: split-half and internal consistency reliability; discriminant, convergent, and predictive validity; and both exploratory and confirmatory factor analyses. The mGBMMS had good internal consistency (overall sample: Cronbach's α = 0.79; Spanish: Cronbach's α = 0.73; English: Cronbach's α = 0.83). The mGBMMS showed good convergent (moderately correlated with the experiences of discrimination scale, r = 0.46, p < 0.001) and discriminant (weakly correlated with the acculturation scale, r = 0.11, p = 0.06) validity. Split-half reliability was 0.71 (p < 0.001). Exploratory and confirmatory factor analyses found a two-factor solution. The mGBMMS was associated with satisfaction with care (OR = 0.60, 95%CI: 0.42-0.87), a sign of good predictive validity. Findings suggest that the mGBMMS is a valid and reliable scale to utilize among bilingual (Spanish/English) populations in the US. Further validation studies should be considered among Latinx respondents of different ages, backgrounds, languages, and US regions.

Experiences of discrimination and endorsement of HIV/AIDS conspiracy beliefs: exploring difference among a sample of Latino, Black, and White young adults.

Racial/ethnic discrimination and HIV/AIDS conspiracy beliefs may contribute to disparities in use and satisfaction with healthcare services. Previous studies that examined racial/ethnic experiences of everyday discrimination (EOD), health care discrimination (HCD), and HIV/AIDS conspiracy beliefs (HCB) focused primarily on African Americans with few studies focusing on Latinos. This study used data from in-person structured interviews with 450 Latino, Black, and White young adults from East Los Angeles, California. Multivariable models, adjusting for all demographic covariates, investigated if race/ethnicity and gender were associated with EOD and HCD and endorsing HCB, and if the associations between race/ethnicity and discriminations and HCB varied by gender. Blacks and Latinos reported more experiences of EOD and HCD in almost all forms and endorsed more HIV/AIDS conspiracy beliefs compared to Whites. Additionally, Black and Latino men reported stronger feelings of EOD than their female counterparts. More reports of experiences of HCD and endorsement of HCB beliefs were found for Blacks, Latinos, and participants with children compared to their counterparts. This study contributes to a growing understanding of how different racial/ethnic groups experience discrimination across various settings and everyday activities and their endorsement of HIV/AIDS conspiracy beliefs. The field of Public Health must address the problems of racism and discrimination similar to any other toxic pathogen. In so doing, Public Health becomes proactive in its efforts to mitigate the effects of racial discriminations on population health.

Dyadic support across contraceptive decision-making among young adult breast cancer survivors and their partners.

OBJECTIVE: The purpose of this study is to explore the role of dyadic support across the contraceptive decision-making process between young adult breast cancer (YABC) survivors and their partners. RESEARCH APPROACH: Semi-structured interviews with YABC survivors and their partners. PARTICIPANTS: Twenty-five young adult breast cancer survivors and their partners (n = 50). Survivors reported an average age of 36.9 years (SD = 4.30) and the majority self-identified as white (86.2%). METHODOLOGICAL APPROACH: Thematic analysis approach with dyads as the primary unit of analysis, guided by the dyadic decision-making framework and the Theory of Gender and Power. RESULTS: Perceived lack of contraceptive options due to a history of hormone-sensitive cancer, perceived infertility, and contraception as a result of cancer treatment (e.g., hysterectomy) contributed to the contraceptive decision context for survivors and their partners. Contraceptive support varied across couples depending on the cancer-specific context, where communication, sharing responsibility, and respecting bodily autonomy revealed as supportive behaviors. Other social influences including survivors' desire to conceive biologically and family planning desires also related to partner supportive behaviors. INTERPRETATIONS: YABC survivors face specific challenges to contraceptive decision-making where partners can offer supportive behaviors. Health care providers can also support couples by engaging in triadic communication about contraception and family planning. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS OR POLICY: Psychosocial providers can support couples by encouraging them to talk together about contraception and highlighting the importance of triadic communication with a healthcare provider to support shared decision-making and alignment of contraceptive decisions with family planning desires.

Impact of Medicaid expansion in Oregon on access to prenatal care.

Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) has the potential to improve reproductive health by allowing low-income women access to healthcare before and early in pregnancy. The aim of this study was to examine the effects of Oregon's Medicaid expansion on timely and adequate prenatal care. We included live births in Oregon from 2012 to 2015 and used individually-linked birth certificate and Medicaid eligibility data. Outcomes were receipt of first trimester prenatal care and receipt of adequate prenatal care. We also assessed Medicaid enrollment one month prior to pregnancy. We estimated the overall effect of Medicaid expansion on prenatal care utilization using probit regression models. Additionally, we assessed the impact of Medicaid expansion on prenatal care utilization via pre-pregnancy Medicaid enrollment using bivariate probit models. Overall, receipt of first trimester prenatal care increased post-expansion by 1.5 percentage points (p < 0.01) after expansion. Receipt of adequate prenatal care also increased significantly post-expansion with an incremental increase of 2.8 percentage points (p < 0.001). Pre-pregnancy Medicaid enrollment increased following Medicaid expansion (ß = 0.55, p < 0.001) and was associated with both timely (ß = 0.48, p < 0.001) and adequate receipt of prenatal care (ß = 0.14, p < 0.001). Using two years of post-ACA data we found that Medicaid expansion had significant positive associations with Medicaid enrollment prior to pregnancy, which subsequently increased receipt of timely and adequate prenatal care. Our study provides evidence that expanding Medicaid has positive effects on women's use of healthcare.

Postpartum Care Utilization Among Women with Medicaid-Funded Live Births in Oregon.

INTRODUCTION: Postpartum care is an important strategy for preventing and managing chronic disease in women with pregnancy complications (i.e., gestational diabetes (GDM) and hypertensive disorders of pregnancy (HDP)). METHODS: Using a population-based, cohort study among Oregon women with Medicaid-financed deliveries (2009-2012), we examined Medicaid-financed postpartum care (postpartum visits, contraceptive services, and routine preventive health services) among women who retained Medicaid coverage for at least 90 days after delivery (n = 74,933). We estimated postpartum care overall and among women with and without GDM and/or HDP using two different definitions: 1) excluding care provided on the day of delivery, and 2) including care on the day of delivery. Pearson chi-square tests were used to assess differential distributions in postpartum care by pregnancy complications (p < .05), and generalized estimating equations were used to calculate adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS: Of Oregon women who retained coverage through 90 days after delivery, 56.6-78.1% (based on the two definitions) received any postpartum care, including postpartum visits (26.5%-71.8%), contraceptive services (30.7-35.6%), or other routine preventive health services (38.5-39.1%). Excluding day of delivery services, the odds of receiving any postpartum care (aOR 1.26, 95% CI 1.08-1.47) or routine preventive services (aOR 1.32, 95% CI 1.14-1.53) were meaningfully higher among women with GDM and HDP (reference = neither). DISCUSSION: Medicaid-financed postpartum care in Oregon was underutilized, it varied by pregnancy complications, and needs improvement. Postpartum care is important for all women and especially those with GDM or HDP, who may require chronic disease risk assessment, management, and referrals.

Patient-Centered Communication to Address Young Adult Breast Cancer Survivors' Reproductive and Sexual Health Concerns.

Women faced with a diagnosis of breast cancer as young adults commonly experience negative effects of cancer and cancer treatment on their reproductive and sexual health (RSH) that are inadequately addressed by their healthcare providers (HCPs). The objectives of this study were to 1) identify approaches to improving RSH communication from YA breast cancer survivors' perspectives, 2) identify facilitators and barriers to the approaches identified, and 3) identify specific strategies to improve patient-centered RSH communication. We conducted individual telephone interviews with 29 women who were diagnosed with breast cancer under age 40 years. We used a grounded theory approach to identify themes, and explored how the themes related to the PCC framework to elucidate specific strategies for improving communication. Three main themes emerged: 1) Normalizing and integrating assessment of RSH concerns; 2) HCP conveying genuine caring and investment; and 3) Improving accessibility of comprehensive RSH services after cancer. Results revealed concrete strategies for improving patient-centered RSH communication at the patient-provider and health system levels. These included reminding patients that RSH concerns are common, routinely asking about RSH, using active listening, and connecting patients to HCP who can address their RSH concerns.

Evaluating the effect of Medicaid expansion on access to preventive reproductive care for women in Oregon.

We evaluated the effect of the Affordable Care Act (ACA) Medicaid expansion on receipt of preventive reproductive services for women in Oregon. First, we compared service receipt among continuing Medicaid enrollees pre- and post-ACA. We then compared receipt among new post-ACA Medicaid enrollees to receipt by continuing enrollees after ACA implementation. Using Medicaid enrollment and claims data, we identified well-woman visits, contraceptive counseling, contraceptive services, sexually transmitted infection (STI) screening, and cervical cancer screening among women ages 15-44 in years when not pregnant. For pre-ACA enrollees, we assessed pre-ACA receipt in 2011-2013 (n = 83,719) and post-ACA receipt in 2014-2016 (n = 103,225). For post-ACA enrollees we similarly assessed post-ACA service receipt (n = 73,945) and compared this to service receipt by pre-ACA enrollees during 2014-2016. We estimated logistic regression models to compare service receipt over time and between enrollment groups. Among pre-ACA enrollees we found lower receipt of all services post-ACA. Adjusted declines ranged from 7.0 percentage points (95% CI: -7.5, -6.4) for cervical cancer screening to 0.4 percentage points [-0.6, -0.2] for STI screening. In 2014-2016, post-ACA enrollees differed significantly from pre-ACA enrollees in receipt of all services, but all differences were <2 percentage points. Despite small declines in receipt of several preventive reproductive services among prior enrollees, the ACA resulted in Medicaid financing of these services for a large number of newly enrolled low-income women in Oregon, which may eventually lead to population-level improvements in reproductive health. These findings among women in Oregon could inform Medicaid coverage efforts in other states.

Navigating sexual health in cancer survivorship: a dyadic perspective.

PURPOSE: This qualitative study examined how young adult breast cancer survivors (YABCS) and their partners appraised and managed their sexual health and intimate relationships after cancer. METHODS: We conducted concurrent, individual telephone interviews with 25 YABCS and their male partners. We utilized a thematic, inductive analysis to examine individual interviews, followed by analysis within and across couples to identify dyadic themes. We explored how themes mapped on to the Theory of Dyadic Illness Management to build a conceptual model specific to the sexual health challenges of young adult couples living with cancer. RESULTS: Our analysis revealed five interconnected themes: (1) shared understanding of physical and psychological challenges of sexual health after cancer, (2) navigating role shifts and changes to sexual relationship, (3) getting through it as a team, (4) maintaining open communication, and (5) need for services and support for partners/caregivers and couples. CONCLUSION: Both survivors and their partners articulated physical (e.g., painful sex, decreased libido) and psychological (e.g., guilt, self-consciousness) challenges to their sexual health in survivorship. Our dyadic focus revealed a spectrum of ways that couples managed the changes to their relationships and sexual health, highlighting "open communication" and strategies for "working as a team" as critical. There is no "one size fits all" solution, as individuals and couples cope with and manage these challenges in different ways. Study results can inform couple-focused intervention strategies, such as creating shared understanding of sexual health after cancer and improving communication skills.

The Association of Cultural and Structural Factors with Perceived Medical Mistrust Among Young Adult Latinos in Rural Oregon.

Although previous studies have examined the impact of medical mistrust on the health and health care seeking behaviors of diverse populations, including Latinos, limited research has explored cultural and structural factors that contribute to medical mistrust. The aim of the present study was to examine the associations between cultural and structural factors and perceived medical mistrust among a sample of young adult Latinos living in rural Oregon. We conducted in-person interviews with 499 young adult Latinos (ages 18-25). Medical mistrust was assessed using a modified version of the Group-Based Medical Mistrust Scale, which has been used with Latino populations. We included three cultural (acculturation, machismo, and familismo) and one structural (perceived everyday discrimination) variables, all measured using previously validated scales. Socio-demographic variables (eg, age, gender, income, educational level, employment) were also included in multivariable linear regression models. We found that everyday discrimination and traditional machismo values were associated with medical mistrust, the latter primarily among Latino women. It is possible that Latinos living in relatively new minority/immigrant settlement areas (such as rural Oregon) may be more vulnerable to experiencing discrimination, which in turn, may erode trust in health care providers. On the other hand, a strong ethnic identity, including the endorsement of machismo values, may serve as a protective mechanism for Latinos confronted by racial/ethnic discrimination. Culturally responsive, socio-cultural, and societal interventions are warranted to tackle the pervasive and ripple effects that racial/ethnic discrimination has on the health of Latinos and other minority populations.

Use of sexual health services among American Indian and Alaska Native Women.

Because use of sexual health services among American Indian/Alaska Native women is understudied we: (1) examined disparities in use of sexual health services between American Indian/Alaska Native and non-Hispanic white women and (2) identified factors associated with service use among American Indian/Alaska Native women. We used data from the National Survey of Family Growth regarding the use of sexual health services collected between 2006 and 2010 from women aged 15-44 years who self-identified as American Indian/Alaska Native (n = 819) and white (n = 6,196). Weighted logistic regression models estimated the likelihood of reporting the use of sexual health services by race and factors associated with use in the American Indian/Alaska Native sample. Compared to whites, American Indian/Alaska Native women were less likely to use birth control services and more likely to use services for sexually transmitted diseases and HIV. Among American Indian/Alaska Natives, younger women were more likely to use birth control services, and women who had a higher number of sexual partners were more likely to use services for sexually transmitted diseases and HIV. Our results provide a national baseline against which to assess disparities and changes in the use of sexual health services among American Indian/Alaska Native women over time.

Oregon's Coordinated Care Organizations and Their Effect on Prenatal Care Utilization Among Medicaid Enrollees.

Introduction Previous studies indicate that inadequate prenatal care is more common among women covered by Medicaid compared with private insurance. Increasing the proportion of pregnant women who receive early and adequate prenatal care is a Healthy People 2020 goal. We examined the impact of the implementation of Oregon's accountable care organizations, Coordinated Care Organizations (CCOs), for Medicaid enrollees, on prenatal care utilization among Oregon women of reproductive age enrolled in Medicaid. Methods Using Medicaid eligibility data linked to unique birth records for 2011-2013, we used a pre-posttest treatment-control design that compared prenatal care utilization for women on Medicaid before and after CCO implementation to women never enrolled in Medicaid. Additional stratified analyses were conducted to explore differences in the effect of CCO implementation based on rurality, race, and ethnicity. Results After CCO implementation, mothers on Medicaid had a 13% increase in the odds of receiving first trimester care (OR 1.13, CI 1.04, 1.23). Non-Hispanic (OR 1.20, CI 1.09, 1.32), White (OR 1.20, CI 1.08, 1.33) and Asian (OR 2.03, CI 1.26, 3.27) women on Medicaid were more likely to receive initial prenatal care in the first trimester after CCO implementation and only Medicaid women in urban areas were more likely (OR 1.14, CI 1.05, 1.25) to initiate prenatal care in the first trimester. Conclusion Following Oregon's implementation of an innovative Medicaid coordinated care model, we found that women on Medicaid experienced a significant increase in receiving timely prenatal care.

Association of perceived partner non-monogamy with prevalent and incident sexual concurrency.

OBJECTIVES: Concurrency is suggested as an important factor in sexually transmitted infection transmission and acquisition, though little is known regarding factors that may predict concurrency initiation. We examined the association between perception of a partner's non-monogamy (PPNM) and simultaneous or subsequent concurrency among at-risk heterosexual young adults in the Los Angeles area. METHODS: We used Poisson regression models to estimate the relationship between PPNM and incident concurrency among 536 participants participating in a cohort study, interviewed at 4-month periods during 1 year. Concurrency was defined as an overlap in reported sexual partnership dates; PPNM was defined as believing a partner was also having sex with someone else. RESULTS: Participants (51% female; 30% non-Hispanic white, 28% non-Hispanic black, 27% Hispanic/Latino) had a mean age of 23 years and lifetime median of nine sex partners. At each interview (baseline, 4-month, 8-month and 12-month), 4-month concurrency prevalence was, respectively, 38.8%, 27.4%, 23.1% and 24.5%. Four-month concurrency incidence at 4, 8 and 12 months was 8.5%, 10.6% and 17.8%, respectively. Participants with recent PPNM were more likely to initiate concurrency (crude 4-month RR=4.6; 95% CI 3.0, 7.0; adjusted 4-month RR=4.0, 95% CI 2.6 to 6.1). CONCLUSIONS: Recent PPNM was associated with incident concurrency. Among young adults, onset of concurrency may be stimulated, relatively quickly, by the PPNM. Programmes which promote relationship communication skills and explicit monogamy expectations may help reduce concurrency.

Can Young Adults Accurately Report Sexual Partnership Dates? Factors Associated With Interpartner and Dyad Agreement.

BACKGROUND: Sexual partnership dates are critical to sexually transmitted infection/HIV research and control programs, although validity is limited by inaccurate recall and reporting. METHODS: We examined data from 302 heterosexual adults (151 index-partner dyads) to assess reliability of reporting. Dates of first sex and last sex were collected through individual interviews and joint dyad questionnaires, which were completed together with their partners. We compared index- and partner-reported dates to estimate interpartner agreement. We used log-linear regression to model associations between interpartner differences and partnership characteristics. To assess validity, we compared individually reported dates with those from joint dyad questionnaires. RESULTS: Most partnerships (66.2%) were 2 years or less in duration, and many (36.2%) were nonmonogamous. Interpartner agreement to within 1, 30, and 365 days was, respectively, 5.6%, 43.1%, and 81.3% for first sex, and 32.9%, 94.5%, and 100.0% for last sex. In adjusted models, longer relationship duration was associated with disagreement on first sex dates; partnership nonmonogamy was associated with disagreement on dates of first sex and last sex. Within dyads, several participant characteristics were associated with reporting dates closer to joint dyad responses (e.g., for first sex date, female sex [54.7%], having fewer sex partners [58.5%], and greater relationship commitment [57.3%]). However, percent agreement to within 30, 60, and 90 days was similar for all groups for both first and last sex dates. CONCLUSIONS: Agreement was high on date of last sex but only moderate on date of first sex. Methods to increase accuracy of reporting of dates of sex may improve STI research.

Effectiveness of a Scaled-Up Arthritis Self-Management Program in Oregon: Walk With Ease.

OBJECTIVES: To evaluate the effectiveness of Walk With Ease (WWE), an evidence-based arthritis self-management program that was scaled up in Oregon in 2012 to 2014. METHODS: Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, we collected participant surveys and attendance records and conducted observations. Preprogram and postprogram, participants self-reported pain and fatigue (scale: 0-10 points; high scores indicate more pain and fatigue) and estimated episodes of physical activity per week in the last month. RESULTS: Recruitment successfully reached the targeted population-sedentary adults with arthritis (n = 598). Participants reported significant reduction in pain (-0.47 points; P = .006) and fatigue (-0.58 points; P = .021) and increased physical activity (0.86 days/week; P < .001). WWE was adopted by workplaces and medical, community, faith, and retirement centers. Most WWE programs were delivered with high fidelity; average attendance was 47%. CONCLUSIONS: WWE is suitable for implementation by diverse organizations. Effect sizes for pain and fatigue were less than those in the original WWE studies, but this is to be expected for a large-scale implementation. Public Health Implications. WWE can be effectively translated to diverse, real-world contexts to help sedentary adults increase physical activity and reduce pain and fatigue.

Individual, Interpersonal, and Structural Power: Associations With Condom Use in a Sample of Young Adult Latinos.

Interviews were conducted with 480 sexually active Latino young adults from four rural counties in Oregon. We examined relationships between three levels of power (individual, interpersonal, and structural) and consistent condom use. Condom use self-efficacy and sexual decision-making, examples of individual and interpersonal measures of power, respectively, were associated with increased odds of consistent condom use among both men and women. Among men only, increasing relationship control, an interpersonal measure of power, was associated with lower odds of consistent condom use. Among women only, increasing medical mistrust, a structural measure of power, was associated with increased odds of consistent condom use.

Concurrent sexual partnerships among young heterosexual adults at increased HIV risk: types and characteristics.

BACKGROUND: The impact of concurrency on sexually transmitted infection transmission depends on coital frequency, condom use, duration of relationship overlap, and number of partners. Previous research has identified distinct concurrency types; however, little is known about their risk characteristics. METHODS: Men (n = 261) and women (n = 275) aged 18 to 30 years at increased risk for acquiring HIV were recruited from community locations in Los Angeles. Participants completed 4 in-person interviews for 12 months. Partnership data were used to characterize the prevalence of 4 types of concurrency: transitional (2 overlapping relationships in which the first relationship ended before the second), single day (a second relationship of 1 day's duration during the course of another relationship), contained (a second relationship >1 day began and ended during the course of another), and multiple (≥3 overlapping relationships). Multilevel random intercept models were used to estimate mean coital frequency, proportion of condom-protected acts, total duration of overlap, and lifetime sex partners. RESULTS: At baseline, 47% of male and 32% of female participants reported any type of concurrency in the previous 4 months, and 26% of men and 10% of women reported multiple concurrencies. Condom use ranged from 56% to 64%, with the highest use in transitional concurrency (61% for men, 68% for women) and the lowest in contained (52% for men, 54% for women). Coital frequency, total overlap, and lifetime sex partners also varied by concurrency type. CONCLUSIONS: Inconsistent condom use and repeated opportunities for exposure characterize common types of concurrency among high-risk young adults.

Identifying virtual care modality in electronic health record data.

Background: Virtual care increased dramatically during the COVID-19 pandemic. The specific modality of virtual care (video, audio, eVisits, eConsults, and remote patient monitoring) has important implications for the accessibility and quality of care, but rates of use are relatively unknown. Methods for identifying virtual care modalities, especially in electronic health records (EHR) are inconsistent. This study (a) developed a method to identify virtual care modalities using EHR data and (b) described the distribution of these modalities over a 3-year study period. Methods: EHR data from 316 primary care safety net clinics throughout the study period (4/1/2020-3/31/2023) were included. Visit type (in-person vs virtual) by adults >18 years old were classified. Expert consultation informed the development of two algorithms to classify virtual care visit modalities; these algorithms prioritized different EHR data elements. We conducted descriptive analyses comparing algorithms and the frequency of virtual care modalities. Results: Agreement between the algorithms was 96.5% for all visits and 89.3% for virtual care visits. The majority of disagreement between the algorithms was among encounters scheduled as audio-only but billed as a video visit. Restricting to visits where the algorithms agreed on visit modality, there were 2-fold more audio-only than video visits. Conclusion: Visit modality classification varies depending upon which data in the EHR are prioritized. Regardless of which algorithm is utilized, safety net clinics rely on audio-only and video visits to provide care in virtual visits. Elimination of reimbursement for audio visits may exacerbate existing inequities in care for low-income patients.