Patient and Community Organization Perspectives on Accessing Social Resources from the Emergency Department: A Qualitative Study

Abstract

Introduction: Social risks adversely affect health and are associated with increased healthcare utilization and costs. Emergency department (ED) patients have high rates of social risk; however, little is known about best practices for ED-based screening or linkage to community resources. We examined the perspectives of patients and community organizations regarding social risk screening and linkage from the ED. Methods: Qualitative interviews were conducted with a purposive sample of ED patients and local community organization staff. Participants completed a brief demographic survey, health literacy assessment, and qualitative interview focused on barriers/facilitators to social risk screening in the ED, and ideas for screening and linkage interventions in the ED. Interviews were conducted in English or Spanish, recorded, transcribed, and coded. Themes were identified by consensus. Results: We conducted 22 interviews with 16 patients and six community organization staff. Three categories of themes emerged. The first related to the importance of social risk screening in the ED. The second category encompassed challenges regarding screening and linkage, including fear, mistrust, transmission of accurate information, and time/resource constraints. The third category included suggestions for improvement and program development. Patients had varied preferences for verbal vs electronic strategies for screening. Community organization staff emphasized resource scarcity and multimodal communication strategies. Conclusion: The development of flexible, multimodal, social risk screening tools, and the creation and maintenance of an accurate database of local resources, are strategies that may facilitate improved identification of social risk and successful linkage to available community resources. [West J Emerg Med. 2020;21(4)964-973.] been used to describe these individual-level, adverse social determinants of health. For the purposes of this paper, we will term these "specific adverse social conditions that are associated with poor health" as social risk. 2 Social risks are

Patient perspectives of discussing social determinants of health with community pharmacists

“…The literature surrounding screening for social needs and risk factors has largely focused on implementation processes and barriers and in the clinic or hospital environment. [16][17][18] Although the challenges and perspectives of providers have been well described, the patient experience and perceptions of discussing SDOH are not well understood. In the nationwide 2018 Consumer Perspectives on How Social Determinants Impact Clinical Experience, a report conducted by Waystar, 19 it was found that 68% of Americans identified having challenges in at least one SDOH risk category.…”

Patient views on emergency department screening and interventions related to housing

“…10 -14 Several studies have explored patient perceptions of addressing social needs in clinical settings, 10 ,12-19 related both to specific domains like intimate partner violence 20,21 and to food insecurity 12,13,17 as well as social needs screening more generally. Most participants across studies agreed that health care providers should ask patients about social needs, 10,12,13,16,18,19 though some added qualifications, including concern for privacy regarding sensitive topics. 14 Less research to date has focused on ED patients' views on social needs screening, 10,13,15,16 with very little devoted to housing issues specifically.…”

“…Most participants across studies agreed that health care providers should ask patients about social needs, 10,12,13,16,18,19 though some added qualifications, including concern for privacy regarding sensitive topics. 14 Less research to date has focused on ED patients' views on social needs screening, 10,13,15,16 with very little devoted to housing issues specifically. One scoping review of ED-based interventions related to social needs found that, of 135 studies, only 3% focused on housing issues.…”

“…While there is consensus that such social factors are important contributors to health, 9 the most effective ways to identify and address them in health care settings are less clear. The literature cites numerous arguments supporting social needs screening in health care settings but also raises concerns, including patients' fear of judgment by clinicians and the limited time available to address both medical and social issues 10–14 . Several studies have explored patient perceptions of addressing social needs in clinical settings, 10,12–19 related both to specific domains like intimate partner violence 20,21 and to food insecurity 12,13,17 as well as social needs screening more generally.…”

“…Less research to date has focused on ED patients' views on social needs screening, 10,13,15,16 with very little devoted to housing issues specifically. One scoping review of ED‐based interventions related to social needs found that, of 135 studies, only 3% focused on housing issues 22 .…”