Addressing barriers to psychology post-pediatric liver transplantation: a multidisciplinary clinic model
Maia Noeder1.
1Behavioral Health, Nemours Children's Hospital, Delaware, Wilmington, DE, United States
Introduction: Social Determinants of Health have an impact on health outcomes and quality of life post-pediatric liver transplantation, with disparities observed in rejection, graft failure, and mortality. Pediatric psychology interventions have been demonstrated to improve adherence, mental health, and quality of life in children with chronic illnesses but at-risk families encounter barriers such as transportation and scheduling limitations when attempting to access traditional outpatient psychology services. Method: To reduce barriers and address negative outcomes associated with health disparities, we developed a multidisciplinary clinic model in which post-transplant patients have a consultation with a pediatric psychology provider twice-yearly in conjunction with their medical visit. Continued in-clinic follow-up and impromptu warm hand-off psychology visits were also available to patients at-risk or experiencing mental health concerns. Pre- and post-implementation data were compared including patient demographics and number of patients seen by psychology per month. Medical provider perceptions on psychology access and barriers were collected via questionnaire. Results: Incorporation of psychology providers into our post-transplant medical clinic led to an increase in the number of patients treated by psychology due to elimination of barriers to care. Patients from underrepresented backgrounds experienced the greatest ratio of increase. Medical providers were found to be generally “dissatisfied” with psychology access pre-implementation and “very satisfied” with access post-implementation. Conclusion: Inclusion of psychology services to address adherence, mental health challenges, and quality of life in post-transplant medical clinics results in improved access to care, particularly for patients from underrepresented backgrounds, and is perceived positively by medical providers.
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