Understanding Racial, Ethnic, and Socioeconomic Differences in the Ambulatory Care Experience.

Autor:	Luff D; Simulator Program (SIMPeds).; Harvard Medical School, Boston, Massachusetts., Buscher SW; Division of General Pediatrics., Ward VL; Office of Health Equity and Inclusion, Department of Radiology.; Harvard Medical School, Boston, Massachusetts., Ballal SA; Division of Gastroenterology, Boston Children's Hospital, Boston, Massachusetts.; Harvard Medical School, Boston, Massachusetts., Holden P; Division of General Pediatrics., Pierre R; Division of General Pediatrics., Won P; Division of General Pediatrics., Yu EJ; Division of General Pediatrics., Toomey SL; Division of General Pediatrics.; Harvard Medical School, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2022 Dec 01; Vol. 150 (6).
DOI:	10.1542/peds.2021-056001
Abstrakt:	Background and Objective: Racial and ethnic and socioeconomic differences in patient experience are prevalent and can negatively impact health outcomes. Our objective was to examine differences in family experience of care in the pediatric ambulatory setting. Methods: We conducted interviews with parents of patients from different demographic groups who had received care at 1 of 3 clinics at a quaternary children's hospital. Multidisciplinary team conducted inductive and deductive thematic analysis of transcribed interviews. Sentiments and recurring themes were compared within and between racial and ethnic groups, insurance status, and language. Results: Eighty parents were interviewed. Three primary themes were identified: (1) mitigation of system issues: parents' mixed experiences with staff or clinicians mitigating system issues impacted their overall perceptions of care; (2) pivotal role of personal interactions: clinicians' interactions positively influenced family-clinician relationships and offset negative experiences; (3) effective explanations: clinicians' clear and thorough explanations were crucial in enhancing parent confidence in care. As an overarching theme, discrimination and disrespect by staff undermined trust in care, affecting all aspects of experience. With the exception of explanations, a higher proportion of publicly-insured parents reported negative experiences across all themes compared to those with private insurance. Asian parents with public insurance had the highest proportion of interviews that were mainly negative in sentiment. Conclusions: Our findings offer nuanced insights into differences in the experience of ambulatory care. Insurance status emerged as an important marker of differential perceptions of care. Our study points to areas for improvement and highlights family-clinician interactions as vital to overall positive experience. (Copyright © 2022 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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