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A multi-site exploration of barriers faced by vulnerable patient populations: a qualitative analysis exploring the needs of patients for targeted interventions in new models of care delivery

  • Bobbie Johannes (a1), Deanna Graaf (a2), Barbara Blatt (a3), Daniel George (a4) and Jed D. Gonzalo (a5)...

Abstract

Aim

To investigate which populations of patients are considered ‘vulnerable’ across varying clinical sites, and to identify the barriers encountered by these patient populations limiting optimal health.

Background

Vulnerable patient populations encounter diverse barriers that limit their ability to successfully navigate the health system, potentially resulting in poor health outcomes. Little current-day work has described types of barriers encountered by vulnerable patient populations across numerous clinical sites and settings, which is necessary to ensure health systems can begin to improve quality and disparities for all patient populations.

Methods

An inductive content analysis was performed based on field-site notes and digitally recorded telephone interviews with providers/leadership at clinics/programs related to patient- and clinic-needs from January 2014 through May 2015. Using thematic analysis with grounded theory techniques, authors identified categories and themes. In total, 30 diverse clinical sites/programs including inpatient- and outpatient-based clinics providing medicine and surgery-based services were assessed through both site visits and follow-up telephone interviews. Follow-up interviews were conducted with one individual in various positions within sites/programs, including physicians (n=15), registered nurses (n=8), clinic managers/coordinators (n=2), clinical program coordinator (n=1), and care coordinator (n=1); one participant represented three clinical sites.

Findings

In total, 30 sites/programs (n=30) received both a site visit and follow-up interview. Commonly reported vulnerable patient populations included those with multiple chronic conditions, lower socioeconomic status, patients in a specific stage in the continuum of care, and patients with over- and under-utilization of resources without a clear etiology. Themes related to barriers included systems barriers (eg, insufficiencies of care processes), clinic barriers (eg, lack of resources), patient-related barriers (eg, housing, transportation), and provider-related barriers (eg, inadequate time and knowledge).

Conclusions

These results provide a framework to identify systems- and clinic-related barriers that can be used in population health management strategies aimed at improving health disparities within clinically diverse sites.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Jed Gonzalo, Division of General Internal Medicine, Penn State Hershey Medical Center, HO34 500 University Drive, Hershey, PA 17033, USA. E-mail: jgonzalo@pennstatehealth.psu.edu

Footnotes

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Cite this article: Johannes B, Graaf D, Blatt B, George D, Gonzalo JD. (2018) A multi-site exploration of barriers faced by vulnerable patient populations: a qualitative analysis exploring the needs of patients for targeted interventions in new models of care delivery. Primary Health Care Research & Development page 1 of 11. doi: 10.1017/S1463423618000385

Footnotes

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