Screening for Social Needs Improves Patient Care, Communication

FOR IMMEDIATE RELEASE: May 9, 2018

Contact:
Leslie Champlin
Senior Public Relations Strategist
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WASHINGTON, DC — Screening patients for economic instability, transportation problems, poor access to food and other social determinants of health can improve both patients’ interactions with their physicians and the care they receive, according to “Clinician Experiences on Screening for Social Needs in Primary Care(www.jabfm.org)” in the May/June issue of the Journal of the American Board of Family Medicine.

Research author Sebastian Tong, M.D., former Robert Graham Center visiting scholar and current assistant professor of family medicine and population health at the Virginia Commonwealth University School of Medicine, sought to determine how primary care clinicians might screen for and consider the impact of social determinants of health. He did so by working with primary care physicians and patients in an area of Northern Virginia where, despite overall affluence, many patients struggle with social deprivation.

Tong recruited primary care clinicians in 12 practices in a Northern Virginia health system. The clinicians participated in a series of four learning sessions on social determinants of health while a small subset of their patients completed a social needs survey.

The practices are within a 45-mile radius of five counties that together have one of the highest average incomes and serve a patient population that is commercially insured, more affluent and use English as their preferred language. However, within the counties, a subset of patients lives in “cold spots,” defined as areas with lower life expectancy and educational attainment, and higher poverty and social deprivation index scores.

In addition to keeping structured diaries for each patient who completed a social needs survey, clinicians participated in four collaborative learning sessions—two before screening patients for social needs and two after patient screening—in which they learned about social needs screening and provided feedback about their experiences and perspectives.

Of the patients living in cold spots, nearly nine in 10 screened positive for at least one of 16 social needs areas. However, only three in 10 wanted help in any area. More than half of the clinicians reported that the social needs survey helped them know their patients better and understand their patients’ finances, relationships with family and friends, beliefs and values, and behavioral health needs.

The screening also helped change care in more than two in 10 patient encounters. Clinicians provided more counseling on exercise and diet, helped address financial barriers to medications and helped with transportation to clinical services.

Among the physicians’ comments: “It’s a reminder that … our patients have lives outside of just the medicine we give them,” one noted. “I took extra time asking her about barriers,” another said. “I was less inclined to assume she did not care about her health,” wrote another.

Despite their greater awareness, the clinicians expressed apprehension about whether screening for social needs could overwhelm a practice. Among their concerns were increased administrative burden and lack of resources to address the identified needs.

“Clinicians in our study spoke about the need for more meaningful resources to address social needs, more education on how to best address social needs and the need for collaborations with community partners to adequately address social needs,” Tong wrote. “Creating these resources and community-clinical partnerships will take substantial work and time; clinicians will need to be supported in these activities if they are to be expected to screen for and address social needs within their practices.”

One solution could focus on the three in 10 patients who requested help, Tong suggested.

“It would likely be overwhelming for primary care clinicians to address social needs in more than half their patients,” he wrote. “However, clinicians could potentially focus on the smaller proportion of patients who sought help with their social needs within the subset of patients identified as living in a cold spot. This approach might make addressing social needs more manageable for primary care clinicians and likely more successful if resources were targeted toward patients who sought help from their clinicians and lived within cold spot communities. Clinicians could then focus on developing resources and community-clinical partnerships in domains where their patients are more likely to seek help.”

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About the Robert Graham Center

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care works to improve individual and population health by enhancing the delivery of primary care. The Center staff generates and analyzes evidence that brings a family medicine and primary care perspective to health policy deliberations at local, state, and national levels.

Founded in 1999, the Robert Graham Center is an independent research unit affiliated with the American Academy of Family Physicians (AAFP). The information and opinions contained in research from the Center do not necessarily reflect the views or policy of the AAFP.