Functional versus Structural Social Support and Health Care Utilization in a Family Medicine Outpatient Practice

Medical Care ◽  
1989 ◽  
Vol 27 (3) ◽  
pp. 221-233 ◽  
Author(s):  
W E Broadhead ◽  
Stephen H. Gehlbach ◽  
Frank V. deGruy ◽  
Berton H. Kaplan
Keyword(s):  
Social Support ◽  
Health Care ◽  
Family Medicine ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Functional Versus ◽  
Outpatient Practice

Depression in Primary Care—More like Asthma Than Appendicitis: The Michigan Depression Project

1997 ◽  
Vol 42 (9) ◽  
pp. 966-973 ◽  
Author(s):  
Michael S Klinkman ◽  
Thomas L Schwenk ◽  
James C Coyne
Keyword(s):  
Social Support ◽  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Family Practice ◽  
Care Setting ◽  
Primary Care Setting ◽  
Past History ◽  
Care Utilization ◽  
Primary Care Patients

Objective: To explore the relationships between detection, treatment, and outcome of depression in the primary care setting, based upon results from the Michigan Depression Project (MDP). Methods: A weighted sample of 425 adult family practice patients completed a comprehensive battery of questionnaires exploring stress, social support, overall health, health care utilization, treatment attitudes, self-rated levels of stress and depression, along with the Center for Epidemiologic Studies Depression Scale (CES-D), the Hamilton Rating Scale for Depression (HAM-D), and the Structured Clinical Interview for DSM-III (SCID), which served as the criterion standard for diagnosis. A comparison sample of 123 depressed psychiatric outpatients received the same assessment battery. Family practice patients received repeated assessment of depressive symptoms, stress, social support, and health care utilization over a period of up to 60 months of longitudinal follow-up. Results: The central MDP findings confirm that significant differences in past history, severity, and impairment exist between depressed psychiatric and family practice patients, that detection rates are significantly higher for severely depressed primary care patients, and that clinicians use clinical cues such as past history, distress, and severity of symptoms to “detect” depression in patients at intermediate and mild levels of severity. As well, there is a lack of association between detection and improved outcome in primary care patients. Conclusion: These results call into question the assumption that “depression is depression” irrespective of the setting and physician, and they are consistent with a model of depressive disorder as a subacute or chronic condition characterized by clinical parameters of severity, staging, and comorbidity, similar to asthma. This new model can guide further investigation into the epidemiology and management of mood disorders in the primary care setting.

scholarly journals Exploring the Role of Co-worker Social Support on Health Care Utilization and Sickness Absence

2011 ◽  
Vol 53 (7) ◽  
pp. 751-757 ◽  
Author(s):  
Sara L. Tamers ◽  
Shirley A.A. Beresford ◽  
Beti Thompson ◽  
Yingye Zheng ◽  
Allen D. Cheadle
Keyword(s):  
Social Support ◽  
Health Care ◽  
Health Care Utilization ◽  
Sickness Absence ◽  
Care Utilization

Social Support, Health Literacy, and Health Care Utilization Among Older Adults

2019 ◽  
Vol 31 (4) ◽  
pp. 359-366 ◽  
Author(s):  
Yong-Bing Liu ◽  
Ping Hou ◽  
Hui-Ping Xue ◽  
Xin-E Mao ◽  
Yong-Nan Li
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Health Care ◽  
Health Literacy ◽  
Nursing Homes ◽  
Health Care Utilization ◽  
Hospital Admissions ◽  
Effective Means ◽  
Care Utilization ◽  
Cross Sectional Survey

The purpose of this study was to explore the relationship between social support, health literacy, and health care utilization in older Chinese adults. A cross-sectional survey design was employed. Data were collected from 32 nursing homes from Urumqi in Xinjiang of China. A total of 1486 respondents completed a pack of questionnaires. The average health literacy level of older adults in nursing homes was relatively low, only 73.68 ± 29.42 points; the average social support level was also relatively low, only 31.42 ± 7.12 points (lower than domestic norm of Chinese residents, P < .001). Both values were below the midpoint for the overall population, indicating a sample with below-average levels of healthy literacy and social support. Low social support levels are associated with poor health literacy and greater likelihood of hospital admission ( P < .05). Social support was significantly associated with health literacy. Improving the quantity and quality of social support may be an effective means to obtain better health literacy and lower hospital admissions.

Patient loneliness in an urban, underserved family medicine residency clinic: prevalence and relationship to health care utilization

2020 ◽  
Vol 37 (6) ◽  
pp. 751-758
Author(s):  
Stephanie A Hooker ◽  
Paul Stadem ◽  
Michelle D Sherman ◽  
Jason Ricco
Keyword(s):  
Primary Care ◽  
Health Care ◽  
African American ◽  
Family Medicine ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Care Clinic ◽  
Family Medicine Residency ◽  
Ed Visits ◽  
The Impact

Abstract Background Mounting evidence suggests that loneliness increases the risk of poor health outcomes, including cardiovascular disease and premature mortality.Objective: This study examined the prevalence of loneliness in an urban, underserved family medicine residency clinic and the association of loneliness with health care utilization. Methods Adult patients (N = 330; M age = 42.1 years, SD = 14.9; 63% female; 58% African American) completed the 3-item UCLA Loneliness screener at their primary care visits between November 2018 and January 2019. A retrospective case–control study design was used to compare health care utilization [hospitalizations, emergency department (ED) visits, primary care visits, no-shows and referrals] in the prior 2 years between patients who identified as lonely versus those who did not. Covariates included demographics and clinical characteristics. Results Nearly half (44%) of patients exceeded the cut-off for loneliness. Patients who were lonely were more likely to identify as African American, have depression and have a substance use disorder. Patients in the lonely group had significantly longer hospital stays and more primary care visits, no-shows and referrals than patients in the non-lonely group; there were no differences in number of hospitalizations or ED visits. Conclusions The prevalence of loneliness in an urban, underserved primary care clinic was much higher than prior prevalence estimates in primary care. Patients who are lonely may use more health care resources than patients who are not lonely. Primary care may be an ideal setting in which to identify patients who are lonely to further understand the impact of loneliness on health care outcomes.

scholarly journals Addressing medical and social needs to reduce unnecessary health care utilization and costs: a qualitative study

2021 ◽  
Author(s):  
DAVID T LISS ◽  
Adriana Guzman ◽  
Emily Walsh ◽  
Sara Shaunfield ◽  
Tiffany Brown
Keyword(s):  
Social Support ◽  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Care Coordination ◽  
Social Needs ◽  
Care Utilization ◽  
Future Research ◽  
Structured Interviews ◽  
Medical Needs

Background: There are few if any well-known approaches to reducing avoidable health care utilization and costs in patients with social needs. This study's objective was to explore the goals, and approaches to organizing and delivering care, of interventions attempting to reduce avoidable resource use by addressing patients' medical and social needs. Methods: Semi-structured interviews were conducted with study investigators about early interventions in the peer-reviewed literature. A template analysis approach was used to review interview transcripts for common themes and create a final code list. Coder dyads separately coded each interview and resolved any discrepancies. Results: Interviews were conducted with 15 investigators of interventions that delivered a variety of health services and addressed several individual social needs. Participants frequently described their overall goal as meeting patients' diverse needs to prevent unnecessary acute care utilization. Reported approaches to addressing medical needs included assistance with receipt of primary care and care coordination across settings. Social needs were described as tightly linked with medical needs; addressing social support and housing were perceived as distinct from addressing other social needs. Participants described their overall approach to meeting patients' needs in terms of establishing connections, partnership, respect, and being adaptable to patients' priorities. Conclusions: Findings shed new light on how to simultaneously address medical and social needs. Opportunities for future research include evaluating different approaches to addressing medical needs (primary care versus care coordination), separately evaluating the impacts of housing or social support, and hiring and training procedures to promote trauma-informed, patient-centered care.

scholarly journals Big Problem or Not a Big Problem: Problems to Health Care Utilization by Residence in The Gambia Among Women of Reproductive Age. A Cross Sectional Study

2021 ◽  
Author(s):  
Ebrima Barrow ◽  
Alieu Sowe
Keyword(s):  
Social Support ◽  
Health Care ◽  
Health Care Utilization ◽  
Health Facility ◽  
Statistical Significance ◽  
The Gambia ◽  
Reproductive Age ◽  
Care Utilization ◽  
Cultural Norms ◽  
Women Of Reproductive Age

Abstract Background: Ability to utilise healthcare services is desire for everyone in need. Unfortunately, challenges to health care utilization persist and they do so inequitably amongst social groups. This study aimed to examine problems to health care utilization and residential area equity in utilization among women of reproductive age in The Gambia. Methods: Data from The Gambia 2019-20 Demographic and Health Survey comprising of 11,865 women 15 – 49 years of age was used. A systematic selection method of equal probability was employed for the data collection interviews. Visiting any health facility in the last 12 months is the outcome. Problems to health care utilization was assessed using four primary factors of interest: permission to go, money needed for treatment, distance to health facility and not wanting to go alone as independent variables. Descriptive and logistic regression analysis were used to assess the frequency distribution and the association of the four factors and health care utilization by residence. The point estimates were reported in odds (OR), 95% confidence interval (CI) and p value <0.05 signified statistical significance.Results: Most women in rural (79%) and urban (83%) residential areas utilized health care services in the last 12 months. Women in urban areas who had a big problem getting permission to go and a big problem not wanting to go alone had lower odds of health care utilization compared to women who did not have a big problem getting permission to go and not wanting to go alone for health care. Women resident in rural areas who reported distance to health facility as a big problem had higher odds of health care utilization compared to women who did not have big problem concerning distance to health facility. Conclusions: Permission to go and not wanting to go alone appear to be associated with cultural norms and inadequate social support for women utilizing health care in urban residence. Policy makers should address harmful cultural norms and inadequate social support for women during health care visits to improve equity in health care utilization towards achieving universal health coverage.

Association of social support with overall survival and health care utilization in patients with aggressive hematologic malignancies.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18582-e18582
Author(s):  
Netana H. Markovitz ◽  
Tamryn Gray ◽  
Sunil Mahesh Bhatt ◽  
Ryan David Nipp ◽  
Nneka Ufere ◽  
...  
Keyword(s):  
Social Support ◽  
Health Care ◽  
Overall Survival ◽  
Length Of Stay ◽  
Health Care Utilization ◽  
Hematologic Malignancies ◽  
Hospitalized Patients ◽  
Care Utilization ◽  
Index Hospitalization ◽  
Prospective Longitudinal

e18582 Background: Social support plays a crucial role for patients with aggressive hematologic malignancies as they navigate their illness course. We examined associations of social support with overall survival and health care utilization in this population. Methods: We conducted a cross sectional secondary analysis using data from a prospective longitudinal cohort study of 251 hospitalized patients with aggressive hematologic malignancies at Massachusetts General Hospital from 2014 through 2017. We utilized Natural Language Processing (NLP) to identify extent of patients’ social support (limited versus adequate as defined by NLP-aided chart review of the Electronic Health Record (EHR)). We used multivariable regression models to examine associations of social support with: 1) overall survival; 2) death or readmission within 90 days of discharge from index hospitalization; 3) time to readmission within 90 days; and 4) index hospitalization length of stay. Results: Patients had a median age of 64 (range: 19-93) years, and most were white (89.6%), male (68.9%), and married (65.3%). A plurality of patients had leukemia (42.2%) followed by lymphoma (37.9%) and myelodysplastic syndrome/myeloproliferative neoplasm (19.9%). Using NLP, we identified that 8.8% (22/251) of patients had limited social support. In multivariable analyses, limited social support was associated with worse overall survival (HR = 2.00, p = 0.042) and higher likelihood of death or readmission within 90 days of discharge (OR = 3.11, P = 0.043), but not with time to readmission within 90 days, or index hospital length of stay. Conclusions: In this cohort of hospitalized patients with aggressive hematologic malignancies, we found associations of limited social support with lower overall survival and higher likelihood of death or readmission within 90 days of hospital discharge. These findings underscore the utility of NLP for evaluating extent of social support and the need for larger studies evaluating social support in patients with aggressive hematologic malignancies.

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