Pa. Margolis et al., LINKING CLINICAL AND PUBLIC-HEALTH APPROACHES TO IMPROVE ACCESS TO HEALTH-CARE FOR SOCIALLY DISADVANTAGED MOTHERS AND CHILDREN - A FEASIBILITY STUDY, Archives of pediatrics & adolescent medicine, 150(8), 1996, pp. 815-821
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 a
nd developmental outcomes was obtained by face-to-face interviews, med
ical chart abstractions, hospital medical records, and state data tape
s. Participants: Ninety-three Medicaid-eligible first-time pregnant wo
men in their third trimester and their subsequently born infants, who
were followed up until they were 6 months old, and 3 pediatric practic
es and 1 family practice. Interventions: Coordinated home visit and of
fice 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 off
ice intervention group were encouraged to seek health care for their i
nfants from one of the primary care practices. Participating offices r
eceived assistance with Medicaid billing, help developing a system to
improve preventive care, and customized patient education materials. R
esults: Mothers reported that the nurses helped them in areas related
to the content of the program. An office system for prevention was dev
eloped 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 prima
ry 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)). Con
clusions: It is feasible to link clinical and public health approaches
to improve the quality and effectiveness of care for socially disadva
ntaged children. Such interventions should be tested in defined popula
tions.