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Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care: A Qualitative Study

IMPORTANCE: Health systems in the US are increasingly screening for social determinants of health (SDOH). However, guidance incorporating stakeholder feedback is limited. OBJECTIVE: To examine patient and care team experiences in early implementation of SDOH screening in primary care. DESIGN, SETTIN...

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Autores principales: Rudisill, A. Caroline, Eicken, Meredith G.A., Gupta, Deeksha, Macauda, Mark, Self, Stella, Kennedy, Ann Blair, Thomas, Darin, Kao, Elise, Jeanty, Mia, Hartley, Jackson
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10685887/
https://www.ncbi.nlm.nih.gov/pubmed/38015502
http://dx.doi.org/10.1001/jamanetworkopen.2023.45444
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author Rudisill, A. Caroline
Eicken, Meredith G.A.
Gupta, Deeksha
Macauda, Mark
Self, Stella
Kennedy, Ann Blair
Thomas, Darin
Kao, Elise
Jeanty, Mia
Hartley, Jackson
author_facet Rudisill, A. Caroline
Eicken, Meredith G.A.
Gupta, Deeksha
Macauda, Mark
Self, Stella
Kennedy, Ann Blair
Thomas, Darin
Kao, Elise
Jeanty, Mia
Hartley, Jackson
author_sort Rudisill, A. Caroline
collection PubMed
description IMPORTANCE: Health systems in the US are increasingly screening for social determinants of health (SDOH). However, guidance incorporating stakeholder feedback is limited. OBJECTIVE: To examine patient and care team experiences in early implementation of SDOH screening in primary care. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study included cross-sectional analysis of SDOH screenings during primary care visits from February 22 to May 10, 2022, primary care team member interviews from July 6, 2022, to March 8, 2023, and patient stakeholder engagement on June 30, 2022. The setting was a large southeastern US health care system. Eligible patients were aged 18 years or older with completed visits in primary care. EXPOSURE: Screening for SDOH in primary care. MAIN OUTCOMES AND MEASURES: Multivariable logistic regression evaluated patient (eg, age, race and ethnicity) and care team characteristics (eg, practice type), and screening completeness. Interviews contextualized the quantitative analysis. RESULTS: There were 78 928 visits in practices conducting any SDOH screening. The population with visits had a mean (SD) age of 57.6 (18.1) years; 48 086 (60.9%) were female, 12 569 (15.9%) Black, 60 578 (76.8%) White, and 3088 (3.9%) Hispanic. A total of 54 611 visits (69.2%) were with a doctor of medicine and 13 035 (16.5%) with a nurse practitioner. Most had no SDOH questions answered (75 298 [95.4%]) followed by all questions (2976 [3.77%]). Logistic regression analysis found that clinician type, patient race, and primary payer were associated with screening likelihood: for clinician type, nurse practitioner (odds ratio [OR], 0.13; 95% CI, 0.03-0.62; P = .01) and physician assistant (OR, 3.11; 95% CI, 1.19-8.10; P = .02); for patient race, Asian (OR, 1.69; 95% CI, 1.25-2.28; P = .001); Black (OR, 1.49; 95% CI, 1.10-2.01; P = .009); or 2 or more races (OR, 1.48; 95% CI, 1.12-1.94; P = .006); and for primary payer, Medicaid (OR, 0.62; 95% CI, 0.48-0.80; P < .001); managed care (OR, 1.17; 95% CI, 1.07-1.29; P = .001); uninsured or with Access Health (OR, 0.26; 95% CI, 0.10-0.67; P = .005), and Tricare (OR, 0.71; 95% CI, 0.55-0.92; P = .01). Interview themes included barriers (patient hesitancy, time and resources for screening and referrals, and number of questions/content overlap) and facilitators (communication, practice champions, and support for patient needs). CONCLUSIONS AND RELEVANCE: This qualitative study presents potential guidance regarding factors that could improve SDOH screening within busy clinical workflows.
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spelling pubmed-106858872023-11-30 Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care: A Qualitative Study Rudisill, A. Caroline Eicken, Meredith G.A. Gupta, Deeksha Macauda, Mark Self, Stella Kennedy, Ann Blair Thomas, Darin Kao, Elise Jeanty, Mia Hartley, Jackson JAMA Netw Open Original Investigation IMPORTANCE: Health systems in the US are increasingly screening for social determinants of health (SDOH). However, guidance incorporating stakeholder feedback is limited. OBJECTIVE: To examine patient and care team experiences in early implementation of SDOH screening in primary care. DESIGN, SETTING, AND PARTICIPANTS: This qualitative study included cross-sectional analysis of SDOH screenings during primary care visits from February 22 to May 10, 2022, primary care team member interviews from July 6, 2022, to March 8, 2023, and patient stakeholder engagement on June 30, 2022. The setting was a large southeastern US health care system. Eligible patients were aged 18 years or older with completed visits in primary care. EXPOSURE: Screening for SDOH in primary care. MAIN OUTCOMES AND MEASURES: Multivariable logistic regression evaluated patient (eg, age, race and ethnicity) and care team characteristics (eg, practice type), and screening completeness. Interviews contextualized the quantitative analysis. RESULTS: There were 78 928 visits in practices conducting any SDOH screening. The population with visits had a mean (SD) age of 57.6 (18.1) years; 48 086 (60.9%) were female, 12 569 (15.9%) Black, 60 578 (76.8%) White, and 3088 (3.9%) Hispanic. A total of 54 611 visits (69.2%) were with a doctor of medicine and 13 035 (16.5%) with a nurse practitioner. Most had no SDOH questions answered (75 298 [95.4%]) followed by all questions (2976 [3.77%]). Logistic regression analysis found that clinician type, patient race, and primary payer were associated with screening likelihood: for clinician type, nurse practitioner (odds ratio [OR], 0.13; 95% CI, 0.03-0.62; P = .01) and physician assistant (OR, 3.11; 95% CI, 1.19-8.10; P = .02); for patient race, Asian (OR, 1.69; 95% CI, 1.25-2.28; P = .001); Black (OR, 1.49; 95% CI, 1.10-2.01; P = .009); or 2 or more races (OR, 1.48; 95% CI, 1.12-1.94; P = .006); and for primary payer, Medicaid (OR, 0.62; 95% CI, 0.48-0.80; P < .001); managed care (OR, 1.17; 95% CI, 1.07-1.29; P = .001); uninsured or with Access Health (OR, 0.26; 95% CI, 0.10-0.67; P = .005), and Tricare (OR, 0.71; 95% CI, 0.55-0.92; P = .01). Interview themes included barriers (patient hesitancy, time and resources for screening and referrals, and number of questions/content overlap) and facilitators (communication, practice champions, and support for patient needs). CONCLUSIONS AND RELEVANCE: This qualitative study presents potential guidance regarding factors that could improve SDOH screening within busy clinical workflows. American Medical Association 2023-11-28 /pmc/articles/PMC10685887/ /pubmed/38015502 http://dx.doi.org/10.1001/jamanetworkopen.2023.45444 Text en Copyright 2023 Rudisill AC et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Rudisill, A. Caroline
Eicken, Meredith G.A.
Gupta, Deeksha
Macauda, Mark
Self, Stella
Kennedy, Ann Blair
Thomas, Darin
Kao, Elise
Jeanty, Mia
Hartley, Jackson
Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care: A Qualitative Study
title Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care: A Qualitative Study
title_full Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care: A Qualitative Study
title_fullStr Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care: A Qualitative Study
title_full_unstemmed Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care: A Qualitative Study
title_short Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care: A Qualitative Study
title_sort patient and care team perspectives on social determinants of health screening in primary care: a qualitative study
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10685887/
https://www.ncbi.nlm.nih.gov/pubmed/38015502
http://dx.doi.org/10.1001/jamanetworkopen.2023.45444
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