Date of Award

January 2020

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Danya Keene

Second Advisor

Marjorie Rosenthal

Abstract

Objective/Purpose: Group Well Child Care is an innovation in primary care delivery that may help meet the quadruple aim of health care. The objective of this study is to characterize Group Well Child Care providers’ experiences, perceptions, and strategies.

Introduction: In Group Care, also known as shared medical appointments, patients with similar medical needs attend appointments together. The practice of Group Care has spread, particularly where social support is beneficial (e.g., early parenting) and among those who might experience shame or stigma for their diagnosis or background (e.g., poverty). Group Care has shown promise in improving patient outcomes, such as adherence to appointments and vaccinations, but the ways that providers experience Group Care has not yet been empirically assessed in a national sample using open-ended interviews.

Methods: Using in-depth interviews with Group Well Child Care providers we explored perceptions of providers’ experience regarding families’ experience and strategies in implementation. We used purposive and snowball sampling methods to capture diversity in terms of geographic location, provider-type, and experience level. Interviews were conducted in-person and via phone/video, transcribed, and coded for key themes by a team of researchers using a grounded theory approach. We conducted interviews until we reached thematic saturation.

Results: We conducted 20 interviews representing individuals from 11 programs across the United States. We identified 4 key themes representing providers’ perceptions and experiences of Group Care: 1) Integrating Peer and Provider Education: the flattened hierarchy between patients and providers resulting from group practice facilitates these complementary types of education, 2) Mindfulness: having multiple families together allows providers to focus on families in the room and not worry about others waiting elsewhere, 3) Community: families who have left a supportive community (e.g., by immigration) welcome shared appointments where they find support, and 4) Organizational Burden: due to its novelty, logistics of group are challenging and frustrating.

Discussion: Despite positive health and health care outcomes in Group Well Child Care, penetration in primary care is limited. Providers’ perceptions of why Group Care might work for families and providers, which families might benefit most from Group Care and what providers need may be key levers in greater implementation of Group Well Child Care.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 11/27/2020

Share

COinS