P3C071: Black Caregiver Perspectives on Continuity of Care in Pediatric Primary Care Settings

Background: Continuity of care, or the experience of seeing the same care provider repeatedly, is associated with improved health outcomes. Racial disparities exist in the degree of continuity of care experienced by patients; Black and Latino/a/x patients are less likely than white patients to experience continuity in the health care they receive. Continuity less commonly occurs in academic teaching practices where care is often provided by trainees (who rotate with dynamic schedules), than in private primary care centers. Patient perspectives on continuity of care in pediatric primary care settings are currently missing from the literature and could inform the development of novel solutions aimed at eliminating disparities in continuity. We sought to elicit Black caregiver perspectives on the most valuable aspects of continuity of care in pediatric primary care settings.

Methods: This was a qualitative study approved by the Institutional Review Board at Cincinnati Children’s Hospital Medical Center. We conducted semi-structured one-on-one interviews with caregivers recruited from three academic primary care practices. An interview guide was co-developed by an interdisciplinary team. Questions within the guide assessed aspects of continuity of care that are most valued by families to optimize their care experience. Interviews were facilitated by a Clinical Research Coordinator (CRC) (white identifying) with the addition of a Black parent researcher when availability allowed, to enhance psychological safety. Interviews were conducted virtually via Zoom and lasted up to 60 minutes. All interviews were recorded, transcribed verbatim, and independently coded line by line by a diverse, trained team (1 CRC, 1 medical student, 1 fellow and 1 attending; 2 coders were Black and 2 were white; all coders were female). A codebook was iteratively developed and modified. Coding was finalized by consensus. Upon reaching thematic saturation, codes were subsequently combined to develop themes that best represented the data.

Results: Transcripts of semi-structured interviews with 11 participants (Table 1) were analyzed. Five main themes emerged from coding the transcripts (Table 2). These five themes were: (1) continuity creates a supportive environment, (2) barriers to continuity are structural, (3) suggested changes should be family-centered and family-informed, (4) caregivers’ experiences with continuity are varied, and (5) caregivers value both continuity and access to care.

Conclusion: Caregivers’ experiences with continuity at their child’s pediatric primary care center vary. Most of the participants interviewed for this qualitative study desired improvements in the continuity of care they currently receive and connected continuity of care to safety, respect, and being valued. Participants also valued access to care. Opportunities exist to promote child health equity by enhancing continuity of care.