Social determinants of health screenings and referrals can increase physician awareness of health risk prevalence. But to be most effective, screening systems need to be tailored to individual clinics, according to new research published in the Journal of the American Board of Family Medicine.
Screening and referral for social determinants of health is in its early stages of implementation and evaluation in clinical practice. Researchers from the Boston University School of Public Health wrote that there is evidence that providers understand the value of screenings, but they find it time-intensive and challenging, which hinders implementation. It is unclear which domains are being targeted, as screening tools vary. The authors also found that it is imperative for clinical staff to achieve routine screening and referral processes.
Ultimately, tailoring screening and including staff in the implementation process could help physicians get better results, researchers found.
The team found that all 15 Boston community health centers screened for social determinants. Each clinic checked for different factors or used the same screening process for both adult and pediatric patients, which signaled that clinics in different locations have different priorities for screening and referrals.
The need to customize social determinants screening by practice could be because of resource availability, specialized staff, local partnerships or aspects of practice, the study authors found.
The average health center screened for eight of the 16 domains in the WE CARE SDoH pilot’s standardized screening. All clinics screened for housing.
“There was little agreement about whether provider perspectives, workflow, prior experience, site resources and staffing and sustainability were barriers or facilitators for implementing the screening, because they were all seen as barriers and facilitators depending on the respondent,” said senior author Mari-Lynn Drainoni, Ph.D., research professor of health law, policy and management at the Boston University School of Public Health.
Drainoni wrote that the findings suggest that tailoring processes and including staff and providers in implementation decisions could help overcome issues with time, workflow and knowledge.
The research team had two goals:
To address the first goal, the team requested and analyzed the social determinants of health screening forms from the 13 clinics. Researchers conducted interviews at three participating study sites on implementation experiences with the WE CARE SDoH screening tool to address the second goal.
Three pediatric centers implemented the WE CARE intervention, which consists of distribution of a screener by medical assistants, entry of responses into the electronic health record, printed resource information sheets for parents and referrals to a patient navigator for additional assistance.
During the interviews, the team focused on understanding the participants’ knowledge of current screening practices and how the WE CARE tool compared with the previous standard of care. The team also explored implementation factors, including staff roles and responsibilities and logistical and patient challenges.
Some participants found the tool helpful, but others considered the repetitive nature of the questions to be off-putting for patients. And some said the tool could be implemented into the workflow easily, while others said the additional screening is too time-consuming.
Of the 13 screening health centers, 11 provided the researchers with social and behavioral screening forms that included patient demographic data and clinic characteristics.
The team identified 16 domains and 78 dimensions of social determinants of health from the documents submitted.
Three centers only screened for social determinants of health in pediatric populations, while one only screened adults.
Three sites participated in interviews with nine physicians, three nurses and 14 medical assistants. Though smaller than the others, these centers had a slightly higher percentage of pediatric visits (30%), more racial and ethnic minority patients and a higher percentage of patients living below 200% of the federal poverty level.
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