OBJECTIVE: Adolescent mental health concerns increased during COVID-19, but it is unknown whether early increases in depression and suicide risk have been sustained. We examined changes in positive screens for depression and suicide risk in a large pediatric primary care network through May 2022.

METHODS: Using an observational repeated cross-sectional design, we examined changes in depression and suicide risk during the pandemic using electronic health record data from adolescents. Segmented logistic regression was used to estimate risk differences (RD) for positive depression and suicide risk screens during the early pandemic (June 2020-May 2021) and late pandemic (June 2021-May 2022) relative to before the pandemic (March 2018-February 2020). Models adjusted for seasonality and standard errors accounted for clustering by practice.

RESULTS: Among 222,668 visits for 115,627 adolescents (mean age 15.7, 50% female), the risk of positive depression and suicide risk screens increased during the early pandemic period relative to the pre-pandemic period (RD: 3.8%; 95% CI: 2.9, 4.8; RD: 2.8%, 95% CI: 1.7, 3.8). Risk of depression returned to baseline during the late pandemic period, while suicide risk remained slightly elevated (RD: 0.7% 95% CI: -0.4, 1.7; RD: 1.8% 95% CI: 0.9%, 2.7%).

CONCLUSIONS: During the early months of the pandemic, there was an increase in positive depression and suicide risk screens, which later returned to pre-pandemic levels for depression but not suicide risk. Results suggest that pediatricians should continue to prioritize screening adolescents for depressive symptoms and suicide risk and connect them to treatment.

<p><strong>PURPOSE: </strong>Pediatric primary care redesign includes changes to clinical teams and clinical workflows. This study described the perspectives of pediatric clinicians on their experience with redesign.</p>

<p><strong>DESIGN AND METHODS: </strong>This qualitative study explored clinician perspectives on a newborn care redesign pilot at a pediatric primary care site. Newborn Hallway (NBH), implemented in 2019, clustered morning newborn visits with a single physician, increased RN staffing, and provided newborn-specific training for RNs. NBH also revised visit documentation templates to promote communication between RNs and physicians and shared completion of history taking and education. We conducted semi-structured qualitative interviews with clinicians. The interview guide was developed using the Consolidated Framework for Implementation Research. Interviews were recorded and transcribed, and coded using an integrated approach.</p>

<p><strong>RESULTS: </strong>We interviewed 17 staff (8 physicians, 8 RNs, 1 nurse practitioner) from 3/2020 to 1/2021. Clinicians reported that NBH implementation was facilitated by widespread agreement on baseline challenges to newborn care, and interest in optimizing roles for RNs. Clinicians believed NBH facilitated teamwork, which mitigated unpredictability in newborn needs and arrival times, and improved staff satisfaction. Perceived barriers to NBH included staffing constraints and ambivalence about whether sharing tasks with RNs would negatively influence patient relationships and continuity.</p>

<p><strong>CONCLUSIONS: </strong>Pediatric primary care redesign focused on sharing tasks between RNs and physicians can promote teamwork and address unpredictability in clinical settings.</p>

<p><strong>PRACTICE IMPLICATIONS: </strong>Resolving questions about how redesign influences patient continuity and trust, and clarifying optimal staffing may help facilitate adoption of clinical team and workflow innovations.</p>