Linking clinical and public health approaches to improve access to health care for socially disadvantaged mothers and children. A feasibility study
P. A. Margolis, C. M. Lannon, R. Stevens, C. Harlan, W. C. Bordley, T. Carey, L. Leininger, L. L. Keyes and J. L. Earp
Department of Pediatrics, University of North Carolina at Chapel Hill, USA.
OBJECTIVE: To test the feasibility of combining home- and office-based
interventions to improve access to health care and health outcomes of
Medicaid-eligible mothers and infants. DESIGN: Randomized trial in 2
counties in North Carolina (1 rural, 1 urban). Information on health and
developmental outcomes was obtained by face-to-face interviews, medical
chart abstractions, hospital medical records, and state data tapes.
PARTICIPANTS: Ninety-three Medicaid-eligible first-time pregnant women in
their third trimester and their subsequently born infants, who were
followed up until they were 6 months old, and 3 pediatric practices and 1
family practice. INTERVENTIONS: Coordinated home visit and office
intervention, office intervention, and usual care. Home visits by 3 public
health nurses provided parental education and social support and linked
families with needed community resources. Women in the office intervention
group were encouraged to seek health care for their infants from one of the
primary care practices. Participating offices received assistance with
Medicaid billing, help developing a system to improve preventive care, and
customized patient education materials. RESULTS: Mothers reported that the
nurses helped them in areas related to the content of the program. An
office system for prevention was developed and implemented in all 4
practices for study patients. Families in the intervention groups were more
likely than control families to have had a prenatal visit with a
pediatrician (P = .01, chi 2), a primary care office as the regular source
of sick care (P = .02, chi 2), and less waiting time (P = .02, Student t
test). They were also more likely to recall receiving patient education
materials (P = .007, chi 2). CONCLUSIONS: It is feasible to link clinical
and public health approaches to improve the quality and effectiveness of
care for socially disadvantaged children. Such interventions should be
tested in defined populations.
