PM3022: “there Is No system:” a Qualitative Description of Pediatric Subspecialty Care for Immigrants from Dallas-area Healthcare Providers

Background: Access to subspecialty pediatric care is limited for low-income immigrant families in Dallas, Texas, largely due to inability to access health insurance coverage. The long-term health, social, and economic implications of untreated chronic health conditions have been well described at the individual and population-health level . With regard to individual health outcomes, the consequences of untreated pediatric disease include increased emergency medicine utilization, decreased quality of life, and higher rates of mortality. In the long run, this system (or lack thereof) not only drastically affects uninsured immigrant children and their families, but also negatively impacts entire communities. This study sought to address such inequities through a qualitative needs analysis conducted via semi-structured interviews with health care providers who frequently care for uninsured immigrant children in need of pediatric subspeciality care. This analysis was intended to inform both further study as well as targeted interventions to improve access to pediatric subspecialty care for uninsured children in immigrant families.

Methods: Based on a phenomenological framework, this qualitative study utilized semi-structured interviews to explore experiences of health care providers caring for uninsured immigrant children who require subspecialty care. Participants were recruited via purposeful and snowball sampling. Interviews were conducted via zoom and transcribed via Sonix. Data analysis was done through an iterative process that involved three phases: coding, categorizing, and identifying themes.

Results: Seventeen pediatric healthcare providers from diverse academic and community practices participated in the study. Themes that emerged included the inefficient and makeshift nature of the current healthcare system for uninsured immigrant children; negative impact on patients, caregivers, and providers; and potential areas of intervention via education, collaboration, and policy/advocacy. There was significant overlap between interviewees in areas of needs and reported barriers (Figure 1) as well as potential interventions including speciality care networks, advocacy and health policy, and community collaboration.

Conclusion: Interventions to improve access to subspecialty care for this population must be tailored to the needs of the community within the constraints of existing barriers and resources. The interviews and subsequent analysis demonstrated the clear need to improve the current infrastructure, defined the barriers, and highlighted potential solutions corroborated by multiple health care professionals. This study laid the foundation for the development of collaborative solutions to address this need via clinical care, education, and advocacy within the Dallas-area but also with potential application to other communities.