Clinicians' Perspectives on Equitable Health Care Delivery in Group Well-Child Care

Ashley Gresh; Noureen Ahmed; Renée Boynton-Jarrett; Mona Sharifi; Marjorie S Rosenthal; Ada M Fenick

doi:10.1016/j.acap.2023.06.010

Clinicians' Perspectives on Equitable Health Care Delivery in Group Well-Child Care

Acad Pediatr. 2023 Sep-Oct;23(7):1385-1393. doi: 10.1016/j.acap.2023.06.010. Epub 2023 Jun 9.

Authors

Ashley Gresh¹, Noureen Ahmed², Renée Boynton-Jarrett³, Mona Sharifi⁴, Marjorie S Rosenthal⁵, Ada M Fenick⁶

Affiliations

¹ Johns Hopkins University School of Nursing (A Gresh), Baltimore, Md.
² Department of Social and Behavioral Science, Yale School of Public Health (N Ahmed and M Sharifi), New Haven, Conn.
³ Department of Pediatrics, Boston University School of Medicine (R Boynton-Jarrett), Mass.
⁴ Department of Pediatrics, Yale School of Medicine (M Sharifi, MS Rosenthal, and AM Fenick), New Haven, Conn; Department of Biostatistics, Yale School of Public Health (M Sharifi), New Haven, Conn.
⁵ Department of Pediatrics, Yale School of Medicine (M Sharifi, MS Rosenthal, and AM Fenick), New Haven, Conn.
⁶ Department of Pediatrics, Yale School of Medicine (M Sharifi, MS Rosenthal, and AM Fenick), New Haven, Conn. Electronic address: ada.fenick@yale.edu.

PMID: 37302699
DOI: 10.1016/j.acap.2023.06.010

Abstract

Objective: To explore clinicians' perspectives about the impact of group well-child care (GWCC) on equitable health care delivery.

Methods: In this qualitative study, we conducted semistructured interviews with clinicians engaged in GWCC recruited via purposive and snowball sampling. We first conducted a deductive content analysis using constructs from Donabedian's framework for health care quality (structure, process, and outcomes) followed by inductive thematic analysis within these constructs.

Results: We completed 20 interviews with clinicians who deliver or research GWCC in 11 institutions across the United States. Four major themes around equitable health care delivery in GWCC emerged from clinicians' perspectives: 1) shifts in power dynamics (process); 2) enabling relational care, social support, and a sense of community (process, outcome); 3) centering multidisciplinary care delivery around patient and family needs (structure, process, and outcomes); and 4) unaddressed social and structural barriers limit patient and family participation.

Conclusions: Clinicians perceived that GWCC enhances equity in health care delivery by shifting hierarchies in clinical visits and promoting relational, patient, and family-centered care. However, potential opportunities exist to further address provider implicit bias in group care delivery and structural inequities at the level of the health care institution. Clinicians underscored the need to address barriers to participation so that GWCC can more fully enhance equitable health care delivery.

Keywords: Equity; Health care delivery; Pediatrics; Primary care; Shared medical appointments.