Prevalence of Unmet Basic Needs and Association with Diabetes Control and Care Utilization Among Insured Persons with Diabetes

Fitzpatrick, Stephanie L.; Banegas, Matthew P.; Kimes, Teresa M.; Papajorgji-Taylor, Dea; Fuoco, Morgan J.

doi:10.1089/pop.2020.0236

Cited by 8 publications

(8 citation statements)

References 34 publications

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“…Unmet social risk factors like lack of access to health insurance, food insecurity, and housing instability create barriers to managing diabetes and are major drivers of poor glycemic control [ 7 ]. Prior to the pandemic, these risk factors drove much of the inequities observed in diabetes morbidity and mortality across sociodemographic groups in the US [ [7] , [8] , [9] ]. Unmet basic needs are highly prevalent, even among patients who are insured, and are associated with poor diabetes-related clinical outcomes [ 8 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Prior to the pandemic, these risk factors drove much of the inequities observed in diabetes morbidity and mortality across sociodemographic groups in the US [ [7] , [8] , [9] ]. Unmet basic needs are highly prevalent, even among patients who are insured, and are associated with poor diabetes-related clinical outcomes [ 8 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Impacts of the COVID-19 pandemic on unmet social needs, self-care, and outcomes among people with diabetes and poor glycemic control

Patel

Zhang

Leung

et al. 2022

Primary Care Diabetes

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impacts of the COVID-19 pandemic on unmet social needs, self-care, and outcomes among people with diabetes and poor glycemic control

Patel

Zhang

Leung

et al. 2022

Primary Care Diabetes

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“…These unmet social needs contribute to uncontrolled diabetes, which leads to major health complications and contributes to diabetes-related morbidity, mortality, and health care costs. 36,37 Quantitatively, there was low use of Z-codes within the EHR; this was not in alignment with the qualitative reports of patient social needs by providers. Providers informally discussed social needs with patients, but they were not systematically using standardized SDOH screeners and were generally unaware of Z-codes as a means to document social needs in the EHR.…”

Section: Discussionmentioning

confidence: 89%

“…While not systematically documented using Z‐codes, qualitative findings suggest that housing and economic circumstances, education, and literacy are critical factors that impact patients. These unmet social needs contribute to uncontrolled diabetes, which leads to major health complications and contributes to diabetes‐related morbidity, mortality, and health care costs 36,37 …”

Section: Discussionmentioning

confidence: 99%

The adoption of social determinants of health documentation in clinical settings

Kepper

Walsh‐Bailey

Prusaczyk

et al. 2022

Health Services Research

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Objective To understand the frequency of social determinants of health (SDOH) diagnosis codes (Z‐codes) within the electronic health record (EHR) for patients with prediabetes and diabetes and examine factors influencing the adoption of SDOH documentation in clinical care. Data Sources EHR data and qualitative interviews with health care providers and stakeholders. Study Design An explanatory sequential mixed methods design first examined the use of Z‐codes within the EHR and qualitatively examined barriers to documenting SDOH. Data were integrated and interpreted using a joint display. This research was informed by the Framework for Dissemination and Utilization of Research for Health Care Policy and Practice. Data Collection/Extraction Methods We queried EHR data for patients with a hemoglobin A1c > 5.7 between October 1, 2015 and September 1, 2020 (n = 118,215) to examine the use of Z‐codes and demographics and outcomes for patients with and without social needs. Semi‐structured interviews were conducted with 23 participants (n = 15 health care providers; n = 7 billing and compliance stakeholders). The interview questions sought to understand how factors at the innovation‐, individual‐, organizational‐, and environmental‐level influence SDOH documentation. We used thematic analysis to analyze interview data. Principal Findings Patients with social needs were disproportionately older, female, Black, uninsured, living in low‐income and high unemployment neighborhoods, and had a higher number of hospitalizations, obesity, prediabetes, and type 2 diabetes than those without a Z‐code. Z‐codes were not frequently used in the EHR (<1% of patients), and there was an overall lack of congruence between quantitative and qualitative results related to the prevalence of social needs. Providers faced barriers at multiple levels (e.g., individual‐level: discomfort discussing social needs; organizational‐level: limited time, competing priorities) for documenting SDOH and identified strategies to improve documentation. Conclusions Providers recognized the impact of SDOH on patient health and had positive perceptions of screening for and documenting social needs. Implementation strategies are needed to improve systematic documentation.

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“…Authors also found that having housing issues (which included problems with both housing quality and housing instability) was associated with higher likelihood of uncontrolled diabetes ( p < 0.05) [ 59 ]. A cross-sectional study of 4043 adult patients with diabetes receiving care at Kaiser Permanente Northwest found that having one or more unmet basic needs (based on a survey which included questions about housing stability and affordability) was associated with an increased odds of having a HbA1c > 8% (63.9 mmol/mol), more outpatient and ED visits, and more delayed refills of diabetes medications compared to having no needs [ 63 ]. A study examining the cumulative association of various social risk factors including housing, food, financial, and utility insecurity in 579 adults with diabetes found that those with three or four social risk factors had a greater likelihood of cost-related medication non-adherence, diabetes distress, and anxiety or depression compared to those with no social risks [ 69 ].…”

Section: Resultsmentioning

confidence: 99%

Housing instability and cardiometabolic health in the United States: a narrative review of the literature

Faulkner

Thorndike

2023

BMC Public Health

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Housing instability is variably defined but generally encompasses difficulty paying rent, living in poor or overcrowded conditions, moving frequently, or spending the majority of household income on housing costs. While there is strong evidence that people experiencing homelessness (i.e., lack of regular housing) are at increased risk for cardiovascular disease, obesity, and diabetes, less is known about housing instability and health. We synthesized evidence from 42 original research studies conducted in the United States examining the association of housing instability and cardiometabolic health conditions of overweight/obesity, hypertension, diabetes, and cardiovascular disease. The included studies varied widely in their definitions and methods of measuring housing instability, but all exposure variables were related to housing cost burden, frequency of moves, living in poor or overcrowded conditions, or experiencing eviction or foreclosure, measured at either the individual household level or at a population level. We also included studies examining the impact of receipt of government rental assistance, which serves as a marker of housing instability given that its purpose is to provide affordable housing for low-income households. Overall, we found mixed but generally adverse associations between housing instability and cardiometabolic health, including higher prevalence of overweight/obesity, hypertension, diabetes, and cardiovascular disease; worse hypertension and diabetes control; and higher acute health care utilization among those with diabetes and cardiovascular disease. We propose a conceptual framework for pathways linking housing instability and cardiometabolic disease that could be targeted in future research and housing policies or programs.

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Prevalence of Unmet Basic Needs and Association with Diabetes Control and Care Utilization Among Insured Persons with Diabetes

Cited by 8 publications

References 34 publications

Impacts of the COVID-19 pandemic on unmet social needs, self-care, and outcomes among people with diabetes and poor glycemic control

Impacts of the COVID-19 pandemic on unmet social needs, self-care, and outcomes among people with diabetes and poor glycemic control

The adoption of social determinants of health documentation in clinical settings

Housing instability and cardiometabolic health in the United States: a narrative review of the literature

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