Patient and Provider Factors that Increase Disclosure of - - PowerPoint PPT Presentation

Patient and Provider Factors that Increase Disclosure of Psychosocial Problems

Jacob Lautze BS1, Julia Tullio BS1, , Deb Lenz MA2, Grace Lubwama DPP3, Catherine Cerulli JD PhD4, Ellen Poleshuck PhD4, Marsha Wittink PhD4, Catherine L. Kothari PhD1

APHA Annual Meeting November 4th Philadelphia, Pennsylvania

• 1. Western Michigan University Homer Stryker M.D. School of Medicine
• 2. Kalamazoo County Health and Community Services
• 3. YWCA of Kalamazoo
• 4. University of Rochester

There are no financial disclosures related to study DISCLOSURE Sponsors: This study was funded by United Way of Battle Creek Kalamazoo

Foundation and by Healthy Babies Healthy Start (Kalamazoo County Health and Community Services). Study findings have been informed by Cradle Kalamazoo partners and Kalamazoo community members.

Background

• Psychosocial risk factors include domestic violence (DV), mental

illness (MH), and substance abuse (SA).

• These common risk factors are harmful to health, especially during

pregnancy.

• Both providers and patients face multiple barriers to disclosure.

Research Objective

• Describe rates of prenatal disclosure and the factors associated with

disclosure.

Psychosocial Risk Factors Domestic Violence Mental Illness Substance Abuse

Disclosure

Methods

• DESIGN: Prospective cross-sectional
• SAMPLE: 300 postpartum women
• RECRUITMENT: Postpartum hospital floors
• Bronson & Borgess (January-September, 2017)
• DATA COLLECTION: Mixed Methods
• Telephone survey conducted 2 months postpartum
• Abstraction medical records
• ANALYSIS: Pearson Chi Square, Linear regression, α<.05

Recruitment

Eligible, 471 Approached, 426 Not, 45 Consented, 300 Not, 126 Completed Survey, 244 Not, 56

Reasons for not completing:

• 2 Withdrew from study
• 32 Never reached
• 22 Declined survey when reached

No differences by race or SES

Measures

Domestic Violence Screen

Mental Illness Screen

Substance Abuse Screen

Results

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00% Prenatal Depression Past Year Problem Drinking Domestic Violence

• In total, 57.3% of women screened

positive for 1 or more psychosocial problems.

Results

Proportion of Women that Screened Positive for 1 or More Problems

1 problem 2 problems 3 problems

Results

0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 60.00% Mental Health Domestic Violence Substance Abuse

Disclosure Rates of Different Problems

• Disclosure rates varied by

problem type.

Results

Factors that increased disclosure Lower Income Multiple Problems

Results

• Provider factors were not significantly associated with disclosure.
• Provider factors include:
• Medical Home
• Primary Care Provider
• Provider Relationship

Limitations

• Majority of limitations are related to the measures

Conclusions

• Disclosure of psychosocial problems, which are common among

pregnant women, was more related to patient circumstances than to provider characteristics

Implications

• We are applying a medical model to a social problem.
• Normally we ask, diagnose and then treat.
• This needs to be chipped because there are so many barriers in being

able to successfully treat.