Ongoing challenges impede efforts to improve the quality of family planning services in underserved communities, which by definition lack sufficient numbers of physicians and other health professionals. Challenges to improving the quality of family planning services include financing difficulties, lack of standards, training deficiencies, as well as little understanding and attention to patient preferences. The objectives of this study were to explore female patients' preferences for family planning services in underserved areas and to develop a framework to help providers improve patient-centered care. The methodology for this paper included mixed methods research including a survey of women between the ages of 18 and 44 in 19 underserved communities (n=1868) across the United States and qualitative research involving 16 focus groups (n=103) to explore patient preferences and experiences with family planning services. Descriptive statistics of survey items and thematic analysis of transcripts were utilized to analyze study data. Triangulation of data sources and methods resulted in an overall framework for patient-centered family planning care. The results show women in underserved areas identified important aspects of family planning care as: relationship with provider, communication, confidentiality in receiving care, provider competence, service access and convenience. The conclusion suggests improving patient-centered care for family planning services could improve outcomes by increasing patient return for follow up care, patient pursuit of other primary and preventive care services, continuation rates of contraceptive method, and higher contraceptive use. Achieving patient-centered family planning care will require investments in human capital and technology, modifications in clinic operations, and an organizational culture focused on patient preferences and experience.

Objective To estimate the impact COVID-19 pandemic on healthcare resource utilization (HCRU) among individuals with major depressive disorder (MDD). Method A retrospective cohort study was conducted to compare HCRU in the twelve months prior to and six months following pandemic onset among 1,318,709 individuals with MDD and propensity-score matched controls. Outcomes were monthly rates of all-cause and MDD-specific outpatient, inpatient, and prescription medication HCRU. Piecewise random effects models were used to adjust for patient-level clustering, trends over time, and pre-pandemic factors. Results In the first month following onset, outpatient HCRU declined with primary care visits down 25.1%. Following this initial decline, outpatient HCRU increased, exceeding pre-pandemic rates within three months. By April 2020, three quarters of all psychotherapy sessions were delivered by telehealth, followed by psychiatry (62.3%), and primary care visits (30.1%). The use of telehealth remained highest for psychotherapy and psychiatry (representing 67.6% and 54.2% of visits, respectively, in September 2020). All-cause partial-day hospitalizations declined 50.5% and remained depressed through July 2020 (down 18.3%). Beginning in the first month post-onset, prescription medication HCRU increased for all antidepressant and antipsychotic medication classes: serotonin modulators ( + 11.8%), bupropion ( + 10.4%), SSRIs ( + 9.0%), SNRIs ( + 8.6%), and atypical antipsychotics ( + 7.5%). Conclusions Following pandemic onset, individuals with MDD realized an immediate, but short-lived, reduction in primary care HCRU. Telehealth use remained elevated through the first six months. The most significant and sustained reduction in HCRU was noted for partial-day hospitalizations and all-cause ED visits.

This report provides guidance to users of National Center for Health Statistics data in the selection of modeling options when using the NCI Joinpoint regression software to analyze trends.

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