Do patients want clinicians to ask about social needs and include this information in their medical record?

Abstract

Background Social needs screening in primary care may be valuable for addressing non-medical health-related factors, such as housing insecurity, that interfere with optimal medical care. Yet it is unclear if patients welcome such screening and how comfortable they are having this information included in electronic health records (EHR). Objective To assess patient attitudes toward inclusion of social needs information in the EHR and key correlates, such as sociodemographic status, self-rated health, and trust in health care. Design, participants, and main measures In a cross-sectional survey of patients attending a primary care clinic for annual or employment exams, 218/560 (38%) consented and completed a web survey or personal interview between 8/20/20-8/23/21. Patients provided social needs information using the Accountable Care Communities Screening Tool. For the primary outcome, patients were asked, “Would you be comfortable having these kinds of needs included in your health record (also known as your medical record or chart)?” Analyses Regression models were estimated to assess correlates of patient comfort with including social needs information in medical records. Key results The median age was 45, 68.8% were female, and 78% were white. Median income was $75,000 and 84% reported education beyond high school. 85% of patients reported they were very or somewhat comfortable with questions about social needs, including patients reporting social needs. Social need ranged from 5.5% (utilities) to 26.6% (housing), and nonwhite and gender-nonconforming patients reported greater need. 20% reported “some” or “complete” discomfort with social needs information included in the EHR. Adjusting for age, gender, race, education, trust, and self-rated health, each additional reported social need significantly increased discomfort with the EHR for documenting social needs. Conclusions People with greater social needs were more wary of having this information placed in the EHR. This is a concerning finding, since one rationale for collecting social need data is to use this information (presumably in the EHR) for addressing needs.

Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care

“…Interviews and patient expert feedback found that patient–care team communication is crucial for screener uptake. Sensitive questions about patient needs may lead to incomplete or untruthful responses if patients have privacy concerns, 10 , 23 feel embarrassed, or fear stigmatization. 24 Patient experts and health care team members emphasized rapport building and communicating the screening purpose to mitigate patient concerns and build trust.…”

Realizing the Potential of Social Determinants Data: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis and Interventions

“…These complemented and expanded the individual-level SDoH data (food/housing security, transportation, interpersonal violence, etc.) captured directly in EHRs [25,26,28,46,73,82,84,[87][88][89][90][91][92][93].…”

Patient Perspectives on Social Risk Screening and Documentation in a Dermatology Clinic

“…Participants completed the survey on a computer tablet before, during, or after their clinic visit. The survey consisted of the 10-item Accountable Health Communities (AHC) healthrelated social needs screening tool, 38,39 which is widely used 28,[40][41][42][43][44] and includes questions on housing, food, transportation, utilities, and interpersonal violence; 2 outcome measures of acceptability; and 20 questions on social risk factors associated with patient acceptability (eAppendix in Supplement 1). We modified questions from an earlier study evaluating acceptability of social risk screening in primary care clinics and EDs 28,45 for use in a dermatology clinic setting.…”