Partly due to their small population size, Pacific Islanders (PIs) are often understudied in mental health research and interventions. Although scant, existing research has documented high rates of mental health issues but low access and use of services among PIs. The purpose of this research was to explore the barriers and facilitators to access and use of mental health care services among PI adults. Face-to-face, one-on-one semistructured interviews were conducted among 12 PI adults living in Southern California who were recruited to the study by trained community leaders. Interviews were recorded, transcribed, and analyzed to identify emergent themes. A total of 5 themes emerged from the interviews: (a) mental health stigma, (b) culture and language barriers, and (c) concerns regarding cost of care and health insurance were themes that emerged around barriers to access and use of mental health services. Themes related to facilitators included (d) family and friend support and (e) the need for outreach and education to increase awareness about mental health. Findings from this research underscore the importance of facilitators to help seeking among PI adults: family, friends, and outreach and education.

IntroductionUnnecessary "admission electrocardiograms (EKGs)" on admitted patients waiting ("boarding") in the emergency department (ED) are often ordered. We introduced evidence-based EKG ordering guidelines and determined changes in the percent of patients with "preadmission" and "admission" EKGs ordered before vs. after guideline introduction and which patient characteristics predicted EKG ordering. MethodsIn 2016, our ED, cardiology, and hospitalist services implemented EKG ordering guidelines to reduce unnecessary ED EKGs ordered after disposition. We compared pre-vs. post-guideline EKG ordering to determine whether guidelines were associated with changes in "preadmission" or "admission EKG" ordering. Patients with an admission diagnosis unrelated to cardiac or pulmonary systems were included. An EKG was "admission" if the order time was after disposition time. The numerator was the number of "admission EKGs" ordered; the denominator was the total number of such admissions; those with "preadmission EKGs" were excluded from this analysis. Variables that might influence EKG ordering were explored. The chisquare test with Bonferroni adjustment was used to compare 2015 vs. 2016 percentages of patients with an "admission EKG." ResultsThere was a decrease in unwarranted "admission EKGs" among ED boarding patients (44.1% preimplementation to 27.5% by two years post-implementation) and an increase in unwarranted "preadmission EKGs" (66.1% pre-implementation to 72.8% post-implementation). Age ≥40 and past medical history independently predicted EKG ordering. DiscussionThe decrease in the ordering of "admission EKGs" but "preadmission EKGs" suggests the decline reflects a true change in ordering and not a general environmental/ecologic decline in ordering. This highlights the importance of careful guideline development and implementation.

No abstract