Assessing Mental Health Concerns of Spanish-Speaking Dairy Farm Workers.

Background: Hispanic dairy farm workers have risk factors for mental health concerns. There is insufficient study of their mental health needs.Methods: We conducted focus groups at five farms. We quantified the burden of depressive symptoms with Patient Health Questionnaires (PHQ-2 and PHQ-9) during three seasons of mobile clinics on farm sites.Results: Focus groups revealed that sources of stress included working conditions, language barriers, fear of deportation, and distance from family. Depression screening found that the rate of mild depressive symptoms ranged from 0% to 3.2%. No individual scored higher than mild depression.Discussion: Rates of depressive symptoms were substantially lower than in the general US population, which may be explained by a population that self-selects for resilience. Our mixed qualitative and quantitative data acquisition provided us a more robust and comprehensive understanding of our population's mental health concerns than using one method alone.

Improving Health Care for Spanish-Speaking Rural Dairy Farm Workers.

BACKGROUND: Dartmouth Geisel Migrant Health (DGMH) is a medical student group that provides on-site health services for Spanish-speaking dairy workers in rural Vermont and New Hampshire in conjunction with a federally qualified health center (FQHC). STUDY OBJECTIVE: This project was undertaken to evaluate and improve the services provided by DGMH and the FQHC and to refine understanding of the target population. METHODS: We surveyed 25 workers at 6 collaborating dairy farms to identify health priorities and concerns and perceived barriers and facilitators to health care for these workers. Surveys were administered over 2 weeks in July 2015. Interpreter-mediated appointment and sliding-fee-scale data from a period 7 months that spanned survey administration were also assessed. RESULTS: Diabetes and hypertension were the most common health concerns. Thirty-two percent of participants reported 10 or more days of depressed mood in the past month. Insurance and language were the most common barriers to health care and employers and on-site clinics were the most common facilitators. Appointments most often addressed women's health, gastrointestinal problems, health maintenance, diabetes, and back pain. Thirty FQHC sliding-fee-scale applications were completed by workers. CONCLUSIONS: These Spanish-speaking dairy-farm workers have many health concerns and perceive substantial barriers to health care. Collaboration between medical students, a rural FQHC, and farm employers provides important services that facilitate health care access among this population.

Ambulatory care education: how do academic medical centers, affiliated residency teaching sites, and community-based practices compare?

PURPOSE: Little is known about how different ambulatory sites compare as clinical educational settings. The authors used students' log data to compare the educational content and processes in academic medical center-based clinics (AMCs), affiliated residency teaching sites (ARTs), and local community-based practices (CBPs) at one medical school. METHOD: Students recorded their experiences with symptoms, counseling, procedures, and common medical conditions as well as characteristics of the learning process during a required eight-week third-year ambulatory clerkship in family medicine. Descriptive statistics, chi-square for differences in categorical variables, and analysis of variance and multivariate analysis of variance for differences in continuous variables were used to compare the educational settings. RESULTS: Over 9,000 encounters were analyzed; 29.7% occurred in AMCs, 14.8% in ARTs, and 55.5% in CBPs. The proportion of continuity visits was lowest in the AMCs and highest in CBPs (13% versus 22%, respectively; p <.01). Students saw almost 57,000 symptoms and conditions. Of 19 symptoms compared, seven differed significantly among the three settings: back pain, cough, dyspnea, ENT (ears, nose, throat problems), fatigue, knee pain, and vomiting. All but one of these were least likely to occur in ARTs. Procedures were performed more frequently, whereas counseling skills were called upon less frequently in CBPs. Students reported being more likely to work unobserved while conducting physical examinations in ARTs and CBPs. Amount of feedback provided on clinical skills did not differ, but students reported receiving more teaching about patient management in ARTs and AMCs versus CBPs (74%, 72%, and 66% of encounters, respectively; p <.01). CONCLUSIONS: Academic and community settings can complement each other as learning sites for an ambulatory clerkship in family medicine, and common curricular expectations can be achieved. Settings' differences and similarities should be taken into account when developing, implementing, or revising clerkship programs and should be considered with students' interests and previous clinical experiences before assigning students to a teaching site.