UCSF

Inequalities in health care delivery are perpetuated through a combination of interpersonal, institutional, and structural factors. This dissertation examines the emergence of a new model of care in relation to health care inequalities and resulting racial/ethnic and socioeconomic disparities in health outcomes. I investigate integrative group medical visits (IGMVs) as an innovation in the structure and process of health care in settings with limited resources, specifically safety-net primary care. IGMVs are a clinic-based intervention that aims to improve patient health by combining biomedical care with complementary health approaches such as acupuncture and yoga, as well as peer support and health education. My research approaches IGMVs as a potential site of addressing inequalities, particularly stratified access to integrative health care.

This mixed-methods project draws on 52 interviews, ethnographic observation of 20 distinct IGMVs, and an exploratory survey. It provides a national overview of safety-net IGMVs in 11 states as well as an in-depth examination of IGMVs at four organizations in California and Massachusetts. The first chapter describes characteristics of IGMV programs, providers, and sites throughout the US, finding that they are most commonly used for chronic conditions including diabetes and chronic pain. The next chapter examines changing social relations made possible by group visits, including an expanded role for patient knowledge. I find that patients take active roles in each other’s care, supporting, challenging, and advocating in ways that shift patient-provider relationships. The final chapter situates the current opioid crisis and related uncertainties surrounding the treatment of chronic pain through safety-net IGMVs. I show how integrative health care is perceived as a safe risk to take against a national context where prescribing and using opioids is seen as comparatively high risk.

This study suggests group visits can restructure patient-provider encounters to interrupt healthcare inequalities, shifting roles and increasing time between patients and providers. My findings point to the promise of group-based care in increasing access to complementary health approaches and providing interdisciplinary care for chronic conditions. Finally, participants in my research articulated how group visits help address trauma at both the individual and community level, in part by breaking social isolation.