Implementation and impact of an online tool used in primary care to improve access to financial benefits for patients: a study protocol

Abstract

ObjectivesAddressing the social determinants of health has been identified as crucial to reducing health inequities. However, few evidence-based interventions exist. This study emerges from an ongoing collaboration between physicians, researchers and a financial literacy organisation. Our study will answer the following: Is an online tool that improves access to financial benefits feasible and acceptable? Can such a tool be integrated into clinical workflow? What are patient perspectives on the tool and what is the short-term impact on access to benefits?MethodsAn advisory group made up of patients living on low incomes and representatives from community agencies supports this study. We will recruit three primary care sites in Toronto, Ontario and three in Winnipeg, Manitoba that serve low-income communities. We will introduce clinicians to screening for poverty and how benefits can increase income. Health providers will be encouraged to use the tool with any patient seen. The health provider and patient will complete the online tool together, generating a tailored list of benefits and resources to assist with obtaining these benefits. A brief survey on this experience will be administered to patients after they complete the tool, as well as a request to contact them in 1 month. Those who agree to be contacted will be interviewed on whether the intervention improved access to financial benefits. We will also administer an online survey to providers and conduct focus groups at each site.Ethics and disseminationKey ethical concerns include that patients may feel discomfort when being asked about their financial situation, may feel obliged to complete the tool and may have their expectations falsely raised about receiving benefits. Providers will be trained to address each of these concerns. We will share our findings with providers and policy-makers interested in addressing the social determinants of health within healthcare settings.Trial registration numberClinicaltrials.gov: NCT02959866. Registered 7 November 2016. Retrospectively registered. Pre-results.

Screening for social determinants of health in clinical care: moving from the margins to the mainstream

“…For instance, the Poverty Tool, as the name suggests, focuses primarily on screening for financial insecurity using the simple phrase “do you have trouble making ends meet at the end of the month” [ 23 ]. This tool is currently in the process of being evaluated in primary care [ 24 ].…”

Employment Interventions in Health Settings: A Systematic Review and Synthesis

“…12,[17][18][19][20][21][22][23][24][25][26] These models emerged in the 1970s from community-based mental health care. 27,28 More recently, primary care organizations have invested in upstream interventions to address the social determinants of health, [29][30][31][32][33][34] including addressing unemployment. For example, interventions based on the Health Leads model use volunteers to connect patients with community resources, including employment.…”

Association of the Social Determinants of Health With Quality of Primary Care

“…[8][9][10][11] Expanding the role of primary care professionals in addressing the social determinants of health is feasible with initiatives that invest upstream and expand the health care team. 12 In the Unites States, health systems increasingly emphasize social determinants through bundled payments, capitation funding models, and, more recently, penalties to hospitals for 30-day readmissions. 13 Efforts to transform primary care delivery, such as placing more emphasis on components of the patient-centered medical home model, 14 have increased the capacity of primary care teams to address patients' needs in a broader interdisciplinary context.…”