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Achieving health equity means making sure everyone gets the resources and care they need to reach their best physical and mental health. Striving to connect people with these resources and care is important.
This is especially true in communities where under-investment in things like schools, parks, public transportation, and internet access can create barriers and limit access to care. Because these barriers are experienced unequally, the people who need care the most have the hardest time getting it.
Ideally, health equity begins with every child receiving the resources and care they need from the moment they’re born. But in underserved communities, children, too, encounter complicated obstacles.
DR. KRISTIN RAY
In our region, pediatric researchers are studying healthcare systems and the families that use them. That includes identifying, understanding, and removing intentional and unintentional barriers. The goal is to create healthcare systems that offer more options, more flexibility, and greater equity.
One of those researchers is University of Pittsburgh’s Dr. Kristin Ray, Associate Professor of Pediatrics and Director of Health Systems Improvement at UPMC Children’s Community Pediatrics. Dr. Ray and her team are working to address social determinants of health (SDoH) by changing and improving how healthcare is delivered to their pediatric patients.
According to the CDC, SDoH are the conditions in which people are born, grow, live, work, and age. These conditions impact people’s physical and mental health and include things like housing, job opportunities, health care, income, education, and social support.
“Healthcare delivery includes both people and systems,” Dr. Ray explains. “Our work focuses on understanding and incorporating patients’ lived experiences. We use that information to help us design systems that make it easier for them to receive care that’s affordable, inclusive, and within reach — in-person and online.”
One of the newest parts of healthcare delivery systems, for example, is telemedicine, which exploded during the pandemic. On the surface, telemedicine appears to be a great solution for people who have a hard time getting their child to a doctor due to the cost, time, and complexity of taking a bus or car.
However, scratch the surface and you’ll find access issues with telemedicine, too. Dr. Ray explains. “Does a parent or caregiver have a smartphone or tablet with a reliable way to charge it? Is their Wi-Fi dependable? Do they have a quiet, safe space where they can connect for the telemedicine visit? Can they download and use the telemedicine app? Does the app work in the language the family speaks? ”
With all these factors to consider, does telemedicine help to achieve health equity or not? Are health systems using telemedicine in ways that help fill the gaps of getting in-person care? And if not, how could it? What other options are there for people if they can’t — or don’t want to — use telemedicine? If telemedicine improves access and quality for some people, does it make their health outcomes better and fairer? What about groups it excludes?
“These are difficult, complicated questions,” says Dr. Ray. “But answering and addressing them is key to reducing ongoing healthcare inequities in our region.”
Dr. Ray’s research includes not only delivery solutions like telemedicine, but also solutions that address healthcare barriers caused by financial hardship, food insecurity, housing support, and neighborhood factors.
Her research begins with small, one-on-one interviews with patients about what’s working with the healthcare system they’re using and what’s not. Researchers ask about pain points and problems with the system and encourage patients to offer ideas about what would make the system smoother and more just.
The interviews are followed by larger, broader surveys. Both methods help to shape changes to healthcare delivery systems. Sometimes the changes are small and local – like making a clinic’s telephone scheduling system easier to use and understand. Sometimes the changes are being addressed by clinics throughout the country, like the best ways to ask patients and parents about food insecurity and transportation barriers. Or how best to support primary care doctors and specialists when they’re moving patients to each other for continued care?
As these types of healthcare system changes are created, Dr. Ray stresses the importance of evaluating and tweaking them. “We need to be mindful of the fact that when we make changes with the goal of allowing people to access healthcare in new and different ways, the changes may make some problems worse or even create new problems,” she says. “That’s why it’s important to keep a close eye on how the changes affect different groups of patients and act immediately to fix problems that keep them from getting the care they need.”
She continues, “For example, with telemedicine, we’re now studying how people use it and its impact on individual and community health outcomes. We’re also interested in how it’s changing the healthcare system itself.”
Whether it’s geographic, social, economic, or some other type of healthcare access barrier, the research model Dr. Ray uses is based on continuous learning. “What do our patients need and how can the pediatric system best support children’s health into adulthood in a way that’s equitable,” she asks. “The answer requires that we ask about, listen to, and understand our patients’ lives and consider all these factors as we shape future research, practice, and policies.”
If you or someone you know has barriers keeping them from getting the care they need (transportation, health insurance, internet or phone access, or healthcare location), contact United Way’s PA 211 Southwest. Call 211, visit pa211sw.org, or text a ZIP Code to 898-211 and receive free, private help from thousands of programs and services in your neighborhood that can make life better and more equitable.
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