Article Figures & Data
Tables
- Table 1.
Baseline Characteristics of Participants from the IBH-PC Trial Who Were Included in the Delay of Care Analysis
Delay of Medical Care Baseline Characteristic No Delay in Medical Care (n = 1188) Delayed Care Only Once (n = 323) Delayed Care More than Once (n = 447) PϮ Mean Age ± SD (years) 65 ± 13 62 ± 13 61 ± 13 <0.001 Male (%) 419 (35%) 122 (38%) 123 (28%) 0.004 White race (%) 893 (76%) 261 (83%) 351 (80%) 0.02 Hispanic (%) 88 (8%) 18 (6%) 37 (8%) 0.34 Married (%) 540 (46%) 174 (54%) 201 (45%) 0.02 Working (%) 296 (25%) 118 (37%) 145 (32%) <0.001 Income <$30,000 (%) 600 (51%) 128 (41%) 238 (54%) <0.001 College graduate (%) 500 (57%) 174 (54%) 240 (55%) <0.001 Presence of food, housing, or financial insecurities (%) 228 (19%) 72 (22%) 147 (33%) <0.001 Mean neighborhood social deprivation index ± SD (units) 54 ± 28 50 ± 28 52 ± 28 0.17 Time between baseline and follow-up surveys (days) 227 ± 38 223 ± 29 225 ± 25 0.08 Mental health summary scoreⱡ 51 ± 9 51 ± 8 47 ± 8 <0.001 Physical health summary scoreⱡ 45 ± 10 46 ± 10 43 ± 9 <0.001 PHQ-9 depression scoreⱡ 5.2 ± 5.4 5.6 ± 5.3 7.6 ± 6.0 <0.001 GAD-7 anxiety severityⱡ 3.6 ± 4.9 4.0 ± 4.7 5.6 ± 5.3 <0.001 Cardiovascular capacity (METs) ⱡ 6.2 ± 2.0 6.6 ± 2.1 6.2 ± 2.0 0.006 Delay of Behavioral Health Care No Delay in Behavioral Health Care (n = 549) Delayed Care Only Once (n = 71) Delayed Care More than Once (n = 122) P Mean Age ± SD (years) 60 ± 14 57 ± 12 56 ± 14 <0.001 Male (%) 172 (32%) 24 (34%) 32 (26%) 0.42 White race (%) 410 (76%) 47 (71%) 88 (73%) 0.61 Hispanic (%) 48 (9%) 3 (5%) 13 (11%) 0.36 Married (%) 206 (38%) 28 (39%) 44 (36%) 0.89 Working (%) 144 (26%) 28 (40%) 37 (30%) 0.05 Income <30K (%) 330 (61%) 37 (53%) 79 (65%) 0.24 College graduate (%) 231 (43%) 33 (47%) 64 (54%) 0.09 Presence of food, housing, or financial insecurities (%) 161 (29%) 30 (42%) 65 (53%) <0.001 Mean neighborhood social deprivation index ± SD (units) 57 ± 28 55 ± 27 59 ± 26 0.50 Time between baseline and follow-up surveys (days) 223 ± 26 224 ± 29 224 ± 26 0.08 Mental health summary scoreⱡ 48 ± 9 45 ± 9 42 ± 7 <0.001 Physical health summary scoreⱡ 44 ± 10 45 ± 9 40 ± 9 <0.001 PHQ-9 depression scoreⱡ 7.9 ± 6.5 9.6 ± 7.1 11.6 ± 6.5 <0.001 GAD-7 anxiety severityⱡ 6.0 ± 5.9 7.4 ± 5.7 9.1 ± 6.0 <0.001 Cardiovascular capacity (METs) ⱡ 6.1 ± 2.0 6.3 ± 1.9 5.6 ± 2.0 0.006 Abbreviations: IBH-PC = Integrated Behavioral Health in Primary Care, the parent study; SD, standard deviation; PHQ, patient health questionnaire; GAD, generalized anxiety disorder; MET, metabolic equivalents.
↵Ϯ P value represents comparison among the 3 groups in the corresponding row using χ2 tests for categorical variables and Kruskal-Wallis tests for continuous variables.
↵ⱡ Measured at time of delay assessment.
- Table 2.
Reasons for Delaying Care Reported by Participants in the IBH-PC Delay of Care Analysis
Reasons for delaying medical care and behavioral health care (Yes) Medical (N = 770) BH (N = 193) I could catch COVID-19 317 (41%) 58 (30%) My practice was not scheduling visits 386 (50%) 87 (45%) I didn't want to bother my provider or the clinic staff 98 (13%) 31 (16%) I thought my symptoms or concerns were mild enough to wait 260 (34%) 47 (24%) I prefer in person visits and the clinic was only offering video or phone visits 127 (17%) 55 (29%) I can't do video or phone 42 (6%) 21 (11%) Some other reason or reasons 118 (15%) 37 (19%) Financial 8 (1%) 4 (2%) Inconvenience 21 (3%) 6 (3%) Unclear 3 (0%) 0 (0%) No reason provided 86 (11%) 27 (14%) Abbreviations: IBH-PC = Integrated Behavioral Health in Primary Care.
Data were collected at the follow-up assessment. Participants could select multiple reasons. Percentages refer to the percent of participants who selected that reason and therefore don’t sum to 100%.
- Table 3.
Mental and Physical Health Outcomes Reported at Follow-up as a Function of Delaying Medical and Behavioral Health Care
Outcome by Delay Category Unadjusted 95% CI P Adjusted 95% CI P Delay of Medical Care *Mental Health Summary Score No Delay in Care (ref) — — — — — — Delayed Care Once −0.76 −1.82, 0.17 0.16 −0.61 −1.29, 0.07 0.08 Delayed Care >1 −4.20 −5.10, −3.24 <0.001 −1.27 −1.87, −0.66 <0.001 *Physical Health Summary Score No Delay in Care (ref) — — — — — — Delayed Care Once 0.77 −0.40, 1.95 0.20 −0.56 −1.28, 0.17 0.13 Delayed Care >1 −2.47 −3.52, −1.44 <0.001 −1.26 −1.91, −0.61 <0.001 PHQ-9 No Delay in Care (ref) — — — — — — Delayed Care Once 0.41 −0.27, 1.10 0.24 0.19 −0.30, 0.69 0.48 Delayed Care >1 2.41 1.81, 3.02 <0.001 0.84 0.39, 1.28 <0.001 GAD-7 No Delay in Care (ref) — — — — — — Delayed Care Once 0.40 −0.21, 1.01 0.20 0.05 −0.40, 0.49 0.84 Delayed Care >1 2.02 1.48, 2.56 <0.001 0.71 0.32, 1.10 <0.001 *METs No Delay in Care (ref) — — — — — — Delayed Care Once 0.37 0.12, 0.62 0.004 −0.12 −0.28, 0.41 0.14 Delayed Care >1 −0.06 −0.29, 0.04 0.61 −0.07 −0.22, 0.08 0.36 Delay of Behavioral Health Care *Mental Health Summary Score No Delay in Care (ref) — — — — — — Delayed Care Once −2.42 −4.53, −0.30 0.03 −0.65 −2.01, 0.80 0.38 Delayed Care >1 −5.56 −7.23, −3.88 <0.001 −1.70 −2.83, −0.57 0.003 *Physical Health Summary Score No Delay in Care (ref) — — — — — — Delayed Care Once 0.63 −1.68, 2.94 0.60 0.49 −1.00, 2.00 0.52 Delayed Care >1 −3.94 −5.77, −2.11 <0.001 −1.17 −2.34, −0.01 0.05 PHQ-9 No Delay in Care (ref) — — — — — — Delayed Care Once 1.73 0.09, 3.36 0.04 0.79 −0.45, 2.04 0.21 Delayed Care >1 3.68 2.38, 4.98 <0.001 1.17 0.20, 2.14 0.02 GAD-7 No Delay in Care (ref) — — — — — — Delayed Care Once 1.40 −0.06, 2.85 0.06 0.29 −0.97, 1.37 0.60 Delayed Care >1 3.12 1.96, 4.28 <0.001 1.34 0.49, 2.20 0.002 *METs No Delay in Care (ref) — — — — — — Delayed Care Once 0.26 −0.25, 0.76 0.32 0.04 −0.32, 0.40 0.83 Delayed Care >1 −0.52 −0.91, −0.12 0.10 −0.26 −0.53, 0.02 0.07 Abbreviations: PHQ, patient health questionnaire; GAD, generalized anxiety disorder; MET, metabolic equivalents.
↵* Higher scores indicate better health.
Adjusted models control for baseline outcome measure, age, sex, race, ethnicity, marital status, income, employment, count of chronic conditions, neighborhood social deprivation, food, housing, and financial social determinants of health, and time into the COVID-19 pandemic.
