Patient Perspectives on Addressing Social Needs in Primary Care Using a Screening and Resource Referral Intervention

Hsu, Clarissa; Cruz, Stephanie; Placzek, Hilary; Chapdelaine, Michelle; Levin, Sara K.; Gutiérrez, F. Morales; Standish, Sara; Maki, Ian V.; Carl, Mary Kathryn; Orantes, Miriam Rosa; Newman, Duffy; Cheadle, Allen

doi:10.1007/s11606-019-05397-6

Cited by 40 publications

(73 citation statements)

References 37 publications

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“…Recent studies have demonstrated that patients were more likely to access an SDOH resource when they received adequate outreach, assistance, and follow-up from staff. 23 , 24 Further, evidence suggests that programs involving direct staff support—compared to “light-touch” interventions (eg, that provide information only)—may be most suitable for effectively addressing SDOH. 25…”

Section: Discussionmentioning

confidence: 99%

“…A qualitative study of patients receiving assistance for SDOH from volunteers reported that the connection with the staff helped them to feel heard and supported. 24 The patient-staff relationship, also known as the therapeutic or working alliance, is associated with adherence, satisfaction, and outcomes in psychotherapy 27 , 28 and medical care 29 - 31 and similarly appears to be an important component of addressing SDOH. Training and supervision of resource staff should emphasize these interpersonal factors that facilitate engagement of patients and ultimately help meet their needs.…”

Section: Discussionmentioning

confidence: 99%

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Addressing Social Determinants of Health Identified by Systematic Screening in a Medicaid Accountable Care Organization: A Qualitative Study

Browne

McCurley

Fung

et al. 2021

J Prim Care Community Health

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Introduction/Objectives: Systematic screening for social determinants of health (SDOH), such as food and housing insecurity, is increasingly implemented in primary care, particularly in the context of Accountable Care Organizations (ACO). Despite the importance of developing effective systems for SDOH resource linkage, there is limited research examining these processes. The objective of the study was to explore facilitators and barriers to addressing SDOH identified by systematic screening in a healthcare system participating in a Medicaid ACO. Methods: This qualitative case study took place between January and March 2020. Semi-structured interviews were conducted with fifteen staff (8 community resource staff and 7 managers) from community health centers and hospitals affiliated with a large healthcare system. Interviews were transcribed, coded, and analyzed using the Framework Method. Results: Facilitators for addressing SDOH included maintaining updated resource lists, collaborating with community organizations, having leadership buy-in, and developing a trusting relationship with patients. Barriers to addressing SDOH included high caseloads, time constraints, inefficiencies in tracking, lack of community resources, and several specific patient characteristics. Further, resource staff expressed distress associated with having to communicate to patients that they were unable to address certain needs. Conclusions: Health system, community, and individual-level facilitators and barriers should be considered when developing programs for addressing SDOH. Specifically, the psychological burden on resource staff is an important and underappreciated factor that could impact patient care and lead to staff burnout.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Addressing Social Determinants of Health Identified by Systematic Screening in a Medicaid Accountable Care Organization: A Qualitative Study

Browne

McCurley

Fung

et al. 2021

J Prim Care Community Health

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“…The Health Leads volunteer advocate model is well-documented 3,5,10 . Patients are referred to advocates based on responses to a paper screening tool developed by Health Leads to assess social needs 11 .…”

Section: Design and Participantsmentioning

confidence: 99%

“…After initial encounters, advocates were expected to follow-up via phone, text, email or in person to determine if patients successfully accessed resources, needed help addressing barriers, and had additional needs. A full description of our sampling strategy, recruitment, data collection and analysis procedures for the interview data has been published previously 5 . Selection criteria included: 1) enrolled in an intervention that is designed to screen for essential social needs and connect individuals to services between June 2014-April 2016, 2) had at least one closed need during that time interval (indicating that the advocate had completed their work with the patient, and either successfully or not successfully met the identi ed needs).…”

Section: Design and Participantsmentioning

confidence: 99%

“…Referrals often link patients to programs outside a healthcare facility such as food pantries, utilities shutoff protections, or housing assistance programs, though in some settings they refer to assistance programs on-site, such as clinic-based food pantries or medical-legal partnerships. A previous paper described patient experiences with a screening and referral program, which provided key insights into how interactions with these programs impact patients both in terms of appropriateness of resource referrals and the establishment of a caring, therapeutic alliance 5 . However, that paper was unable to explore in depth the barriers that patients face when trying to connect to community resources.…”

Section: Introductionmentioning

confidence: 99%

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Intersecting Systemic and Personal Barriers to Accessing Social Services: Qualitative Interviews in Northern California

Placzek

Cruz

Chapdelaine

et al. 2021

Preprint

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Background. Addressing social risks in the clinical setting can increase patient confidence in the availability of community resources and may contribute to the development of a therapeutic alliance which has been correlated with treatment adherence and improved quality of life in mental health contexts. It is not well understood what barriers patients face when trying to connect to community resources that help address social risks.Methods. This is a qualitative assessment of patient-reported barriers to accessing and using social needs assistance programs. We conducted over 100 in-depth interviews with individuals in Northern California who participated in a navigation and referral program to help address their social needs and describe a unique framework for understanding how policies and systems intersect with an individual's personal life circumstances.Results. Individuals described two distinct domains of barriers: 1) systems-level barriers that were linked to the inequitable distribution of and access to resources, and 2) personal-level barriers that focused on unique limitations experienced by each patient and impacted the way that they accessed services in their communities. While these barriers often overlapped or manifested in similar outcomes, this distinction was key because the systems barriers were not things that individuals could control or overcome through their own initiative or by increasing individual capacity.Conclusions. Respondents describe intersecting systemic and personal barriers that compound patients’ challenges to getting their social needs met; this includes both a picture of the inequitable distribution of and access to social services and a profile of the limitations created by individual life histories. These results speak to the need for structural changes to improve adequacy, availability, and accessibility of social needs resources. These findings highlight the need for advocacy to address systems barriers, especially the stigma that is faced by people who struggle with a variety of health and social issues, and investment in incentives to strengthen relationships between health care settings and social service agencies.

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How Should Clinicians Ally With Patients Whose Health Is Unlikely to Be Improved by Even Numerous Clinical Encounters?

2022

AMA Journal of Ethics

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Patients experiencing homelessness and mental illness face conditions and circumstances that deserve focused ethical and clinical attention. The first commentary on the case applies insights from qualitative research about social determinants of health to these patients' care and dignity. The second commentary describes 3 kinds of power wielded by physicians-charismatic, social, and Aesculapian-each of which is considered in terms of whether and to what extent physicians' power should be owned, aimed, or shared.Case JJ is a 27-year-old man with schizophrenia, who is brought to the clinic by staff members from a local shelter. JJ does not adhere well to his antipsychotic medication, has experienced several inpatient psychiatric civil commitments and other encounters with numerous clinicians in the region's health care system, and does not have reliable access to shelter, food, water, or hygiene. You, JJ's caregiver in the clinic right now, empathize with him, staff from the shelter, and others trying to help JJ avoid poor health outcomes for which he is at such high risk.You refilled JJ's medication and reviewed his laboratory values, but you know there is little you can do for JJ that can counter the myriad and well-known social determinants undermining the effectiveness of even the most skilled intervention any clinician could offer JJ during a clinical encounter. You wonder how to make the most of this moment you have with JJ on his life journey.

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Patient Perspectives on Addressing Social Needs in Primary Care Using a Screening and Resource Referral Intervention

Cited by 40 publications

References 37 publications

Addressing Social Determinants of Health Identified by Systematic Screening in a Medicaid Accountable Care Organization: A Qualitative Study

Addressing Social Determinants of Health Identified by Systematic Screening in a Medicaid Accountable Care Organization: A Qualitative Study

Intersecting Systemic and Personal Barriers to Accessing Social Services: Qualitative Interviews in Northern California

How Should Clinicians Ally With Patients Whose Health Is Unlikely to Be Improved by Even Numerous Clinical Encounters?

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