Barriers to the use of preventive health care services for children.

This article describes findings from interviews of parents targeted for outreach efforts that encouraged them to use Medicaid's Early and Periodic Screening, Diagnosis and Treatment(EPSDT) Program. Begun in the 1970s, the EPSDT program held out the promise of ensuring that needy children would receive comprehensive preventive care. With only one-third of eligible children in the United States receiving EPSDT checkups, the program has yet to fulfill its promise. This study sought to understand parents' perceptions of barriers to using EPSDT by interviewing (a) 110 parents who did not schedule EPSDT checkups for their children after being exposed to outreach efforts and (b) 30 parents who did. Although the EPSDT Program is designed to provide health care at no charge and to provide assistance with appointment scheduling and transportation, these low-income parents identified significant barriers to care. Reasons for not using EPSDT services included (a) competing family or personal issues and priorities; (b) perceived or actual barriers in the health care system; and (c) issues related directly to problems with the outreach efforts. Parents who successfully negotiated these barriers and received EPSDT services encountered additional barriers, for example, scheduling and transportation difficulties, long waiting room times, or care that they perceived to be either unresponsive to their medical needs or interpersonally disrespectful. The implications for future outreach efforts and improving access to preventive health care services are discussed.

Diversity in the rural poor: differences between households with and without telephones.

Differences between households with and without phones in the United States as a whole are well documented, but these differences, and their implications for nursing practice and research, have received little attention in nursing publications. This article 1) reviews findings from national studies of these differences and 2) reports on a nursing study that examined such differences specifically in a random sample (N = 2,053) of low-income families having children eligible for but not using the well-child services of the Medicaid program in rural North Carolina. The study was part of a randomized trial of nursing interventions to encourage parents to use these services. The analyses reported herein focus on how families with and without phones differed in health-related characteristics and in responses to the interventions. The findings have relevance for public health nurses conducting outreach or research with similar low-income families, even when the outreach or research methods do not involve phone contact.

Increasing Medicaid child health screenings: the effectiveness of mailed pamphlets, phone calls, and home visits.

OBJECTIVES: A randomized controlled trial was conducted to test the effectiveness and cost effectiveness of three outreach interventions to promote well-child screening for children on Medicaid. METHODS: In rural North Carolina, a random sample of 2053 families with children due or overdue for screening was stratified according to the presence of a home phone. Families were randomly assigned to receive a mailed pamphlet and letter, a phone call, or a home visit outreach intervention, or the usual (control) method of informing at Medicaid intake. RESULTS: All interventions produced more screenings than the control method, but increases were significant only for families with phones. Among families with phones, a home visit was the most effective intervention but a phone call was the most cost-effective. However, absolute rates of effectiveness were low, and incremental costs per effect were high. CONCLUSIONS: Pamphlets, phone calls, and home visits by nurses were minimally effective for increasing well-child screenings. Alternate outreach methods are needed, especially for families without phones.

Obtaining telephone numbers for a rural Medicaid population: issues for outreach and research.

This study examined the accuracy and costs of determining whether rural, low-income Medicaid recipients did or did not have a phone, and of obtaining phone numbers for those who did. For a random sample of 209 families, we compared phone information obtained from phone books and directory assistance with information obtained from department of social services (DSS) records. DSS records identified 51% of the sample as having phones, compared with 19%-25% for phone books and directory assistance. For identifying families as having no home phone or a phone with a number that matched the one in the DSS record, phone books or directory assistance corresponded with DSS records in 52%-57% of the sample. Using phone books or directory assistance was up to 3.2 times more costly than using DSS records. The study highlighted the need to establish policies to promote the exchange of information between social services and public health agencies and researchers.