Group Care for the Pediatric Well-Child Population: A qualitative study
Creators: name: Brier, Sarah
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2007

description: Background: The Institute of Medicine and Future of Family Medicine Project encourage physicians to develop innovative models of care to better meet patients' changing health care needs. Although interest in the group care model is growing, little is known about the practicality and application of group visits for infant well-child care. We created and implemented a group model of well-child visits, WellBabies. As an initial step to assess well-child group visits, we conducted a study to explore the experiences and perceptions of parents who participated in the WellBabies program. The specific aims of the study were to: (1) understand parents' preferences and rationales for choosing the WellBabies program instead of regular care; (2) determine parents' opinions regarding favorable and unfavorable aspects ofWellBabies; (3) understand parents' needs and preferences regarding the preventive well-child visits; and (4) elicit feedback for improvement of the WellBabies program. Methods: In preparation for this exploration, a systematic review ofliterature pertaining to pediatric well-child group visits was performed in order to obtain evidence on the development, utilization and progress of the group visit. The MEDLINE database and Cochrane Library were searched, and articles from 1972 - 2007 were selected based on outlined criteria. Then, individual semi-structured interviews were conducted with mothers who participated in the WellBabies program at an academic family medicine center. 13 mother-infant dyads of WellBabies participants to date were invited: 8/13 were first time moms, 5113 were privately insured. Editing analysis was used to code the transcribed data and identify emerging themes. Health information was extracted from the patients' charts for descriptive purposes. Results: The systematic review of the literature included seven studies satisfying the outlined criteria. The studies were of varying quality, used diverse designs and examined a variety of outcomes. All of the studies found that group visits were at least as efficient and effective as the individual visits. In two studies examining patient satisfaction or perception, group visits were found to be a positive experience with at least equivalent satisfaction as individual visits. In the interviews with WellBabies participants, most frequently given reasons to participate include additional support from other parents and the provider, additional time with the doctor, and desire for a social activity. Participants enjoyed many aspects ofthe visit including the structure of the group visits, the widespread support and having other children to see and learn from. Few participants had dislikes, but suggestions for improvement included additional administrative support and patient education materials. Only one of the 13 participants said that lack of individual time was a disadvantage of the group visits. Discussion: WellBabies group visits appear to be a positive experience for the participants and a promising alternative model of care. Next steps include increasing organization and developing comprehensive education materials for the participants. Future study includes a cost effectiveness evaluation of the WellBabies program and a prospective comparison of health outcomes and quality indicators between patients receiving individual versus group care.