title: A qualitative analysis of interprofessional healthcare team members' perceptions of patient barriers to healthcare engagement.
abstract: Healthcare systems increasingly engage interprofessional healthcare team members such as case managers, social workers, and community health workers to work directly with patients and improve population health. This study elicited perspectives of interprofessional healthcare team members regarding patient barriers to health and suggestions to address these barriers.
  
  
  
  This is a qualitative study employing focus groups and semi-structured interviews with 39 interprofessional healthcare team members in Philadelphia to elicit perceptions of patients' needs and experiences with the health system, and suggestions for positioning health care systems to better serve patients. Themes were identified using a content analysis approach.
  
  
  
  Three focus groups and 21 interviews were conducted with 26 hospital-based and 13 ambulatory-based participants. Three domains emerged to characterize barriers to care: social determinants, health system factors, and patient trust in the health system. Social determinants included insurance and financial shortcomings, mental health and substance abuse issues, housing and transportation-related limitations, and unpredictability associated with living in poverty. Suggestions for addressing these barriers included increased financial assistance from the health system, and building a workforce to address these determinants directly. Health care system factors included poor care coordination, inadequate communication of hospital discharge instructions, and difficulty navigating complex systems. Suggestions for addressing these barriers included enhanced communication between care sites, patient-centered scheduling, and improved patient education especially in discharge planning. Finally, factors related to patient trust of the health system emerged. Participants reported that patients are often intimidated by the health system, mistrusting of physicians, and fearful of receiving a serious diagnosis or prognosis. A suggestion for mitigating these issues was increased visibility of the health system within communities to foster trust and help providers gain a better understanding of unique community needs.
  
  
  
  This work explored interprofessional healthcare team members' perceptions of patient barriers to healthcare engagement. Participants identified barriers related to social determinants of health, complex system organization, and patient mistrust of the health system. Participants offered concrete suggestions to address these barriers, with suggestions supporting current healthcare reform efforts that aim at addressing social determinants and improving health system coordination and adding new insight into how systems might work to improve patient and community trust.
authors.affiliation: Department of Medicine, Thomas Jefferson University, 833 Chestnut St, Suite 701, Philadelphia, PA, 19107, USA. Rhea.powell@jefferson.edu.
authors.forename: Rhea E
authors.initials: RE
authors.lastname: Powell
authors.affiliation: College of Public Health, Temple University, Philadelphia, PA, USA.|Department of Emergency Medicine, Thomas Jefferson University, 1025 Walnut Street, 300 Curtis Building, Philadelphia, PA, 19107, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Doty
authors.affiliation: Department of Psychiatry and Human Behavior, Thomas Jefferson University, 900 Walnut Street, 2nd floor, Philadelphia, PA, 19107, USA.
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Casten
authors.affiliation: Departments of Neurology and of Psychiatry and Human Behavior, Thomas Jefferson University, 900 Walnut Street, Suite 200, Philadelphia, PA, 19107, USA.
authors.forename: Barry W
authors.initials: BW
authors.lastname: Rovner
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, 1025 Walnut Street, 300 Curtis Building, Philadelphia, PA, 19107, USA.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Rising
mesh_terms: D001291:Attitude of Health Personnel; D003153:Community Health Services / Q000706:statistics & numerical data*; D003150:Community Health Workers / Q000523:psychology*; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010348:Patient Care Team; D010465:Perception; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D011203:Poverty; D036301:Qualitative Research; D012947:Social Work
keywords: Determinants of health/Population health; Healthcare needs and demand; Organization; Social determinants of health; Structure and delivery of healthcare