Patients’ social determinants of health were determined in 1 minute with a short survey, according to findings recently published in Annals of Family Medicine.
A second article, appearing in the Journal of the American Board of Family Medicine, found a lack of consensus among clinicians on which of those determinants to screen for.
With previously published studies finding that the average primary care visit in the U.S. is barely 21 minutes long and almost 70% of health outcomes attributable to social determinants of health, the new findings suggest a potential measure PCPs can take to improve patients’ health without adding significantly to the length of a visit.
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In the first article, 731 patients entering either an ED or general internal medicine department took a 60-second survey regarding age and sex, and whether or not they needed help within the last 30 days regarding day care, domestic violence, education, employment, food, housing, legal services, safety, substance abuse, transportation, utilities or other such social need.
Researchers found that more than 60% of patients reported at least one unmet social need. Among both groups, there were “significant clusters” of patients reporting two needs (8.1% general internal medicine; 7.8% ED) or three or more needs (18.4% general internal medicine; 15.5% ED). Also, transportation (26.8% general internal medicine; 18.4% ED), food (23.1% general internal medicine; 16.9% ED) and housing (14.2% general internal medicine; 12.7% ED) were the most frequently cited needs.
“Little to no patient instruction is required to complete the 15-item checklist,” Sarah R. Reves, MSN, of the department of family medicine and population health at Virginia Commonwealth University, and colleagues wrote of their questionnaire.
“Ease of survey use by general internal medicine nurses demonstrates low burden on staff and workflow. This survey could easily be used in primary care settings, through front desk paperwork or with rooming staff. Similarly, primary care practices with limited time and resources can prioritize and target community partnerships of most value to their patients once rates of unmet social needs are identified,” they added.
Little agreement among practitioners
In the second article, Elena Byhoff, MD, MSc, of the department of medicine at Tufts Medical Center and colleagues reviewed the process behind standardized social determinants of health screening and referrals at 15 pediatric-focused community health centers.
“With increasing focus on social determinants of health screening and referral interventions, it is critically important to establish implementation best practices,” they wrote.
Byhoff and colleagues found that the centers’ staff screened for a mean of eight domains. However, previous experiences, provider perspectives, site resources and staffing, sustainability and workflow resulted in “no agreement” on which domains to screen for and “little agreement” on how to overcome these differences.
Researchers suggested ways to remove these barriers as they discussed the findings.
“Future work should incorporate feedback from the clinical team to improve the implementation plan, further educate site staff on study purpose and protocol, improve integration of the patient navigator into care teams, and report study outcomes to motivate further participation by providers and clinical staff,” Byhoff and colleagues wrote.
“Engaging providers and patients in prioritizing social determinants of health screening domains to maximally benefit the patient population may encourage more provider agreement in routine social determinants of health screening protocols. Ongoing opportunities for provider and staff feedback will improve workflow and protocol buy in, while allowing for site specific tailoring to clinic resources and patient needs.” – by Janel Miller
Date: May 15, 2019