scholarly journals Implementation and impact of an online tool used in primary care to improve access to financial benefits for patients: a study protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e015947 ◽  
Author(s):  
Anjana Aery ◽  
Anne Rucchetto ◽  
Alexander Singer ◽  
Gayle Halas ◽  
Gary Bloch ◽  
...  
Keyword(s):  
Primary Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Low Income ◽  
Online Survey ◽  
Determinants Of Health ◽  
Advisory Group ◽  
Online Tool ◽  
Financial Benefits ◽  
The Social

ObjectivesAddressing the social determinants of health has been identified as crucial to reducing health inequities. However, few evidence-based interventions exist. This study emerges from an ongoing collaboration between physicians, researchers and a financial literacy organisation. Our study will answer the following: Is an online tool that improves access to financial benefits feasible and acceptable? Can such a tool be integrated into clinical workflow? What are patient perspectives on the tool and what is the short-term impact on access to benefits?MethodsAn advisory group made up of patients living on low incomes and representatives from community agencies supports this study. We will recruit three primary care sites in Toronto, Ontario and three in Winnipeg, Manitoba that serve low-income communities. We will introduce clinicians to screening for poverty and how benefits can increase income. Health providers will be encouraged to use the tool with any patient seen. The health provider and patient will complete the online tool together, generating a tailored list of benefits and resources to assist with obtaining these benefits. A brief survey on this experience will be administered to patients after they complete the tool, as well as a request to contact them in 1 month. Those who agree to be contacted will be interviewed on whether the intervention improved access to financial benefits. We will also administer an online survey to providers and conduct focus groups at each site.Ethics and disseminationKey ethical concerns include that patients may feel discomfort when being asked about their financial situation, may feel obliged to complete the tool and may have their expectations falsely raised about receiving benefits. Providers will be trained to address each of these concerns. We will share our findings with providers and policy-makers interested in addressing the social determinants of health within healthcare settings.Trial registration numberClinicaltrials.gov:NCT02959866. Registered 7 November 2016. Retrospectively registered. Pre-results.

scholarly journals Screening for poverty and intervening in a primary care setting: an acceptability and feasibility study

2019 ◽  
Vol 36 (5) ◽  
pp. 634-638
Author(s):  
Andrew D Pinto ◽  
Madeleine Bondy ◽  
Anne Rucchetto ◽  
John Ihnat ◽  
Adam Kaufman
Keyword(s):  
Primary Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Low Income ◽  
Determinants Of Health ◽  
Health Concern ◽  
Evidence Based ◽  
Health Providers ◽  
Financial Benefits ◽  
The Social

Abstract Background A movement is emerging to encourage health providers and health organizations to take action on the social determinants of health. However, few evidence-based interventions exist. Digital tools have not been examined in depth. Objective To assess the acceptability and feasibility of integrating, within routine primary care, screening for poverty and an online tool that helps identify financial benefits. Methods The setting was a Community Health Centre serving a large number of low-income individuals in Toronto, Canada. Physicians were encouraged to use the tool at every possible encounter during a 1-month period. A link to the tool was easily accessible, and reminder emails were circulated regularly. This mixed-methods study used a combination of pre-intervention and post-intervention surveys, focus groups and interviews. Results Thirteen physicians participated (81.25% of all) and represented a range of genders and years in practice. Physicians reported a strong awareness of the importance of identifying poverty as a health concern, but low confidence in their ability to address poverty. The tool was used with 63 patients over a 1-month period. Although screening and intervening on poverty is logistically challenging in regular workflows, online tools could assist patients and health providers identify financial benefits quickly. Future interventions should include more robust follow-up. Conclusions Our study contributes to the evidence based on addressing the social determinants of health in clinical settings. Future approaches could involve routine screening, engaging other members of the team in intervening and following up, and better integration with the electronic health record.

Primary Care and the Social Determinants of Health: Lessons on Care Models, Capacity, and Culture for the Journey Upstream

2019 ◽  
pp. 75-86
Author(s):  
Rishi Manchanda
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Community Health Center ◽  
Care Physician ◽  
Determinants Of Health ◽  
The Social ◽  
Care Models ◽  
Value Based Care

This chapter looks at the issue of advances in public health and efforts with collaboration from the perspective of a primary care physician at a community health center. It specifically looks at how much has evolved in a ten-year span. Thanks to increasing payer commitment to value-based care, the concept of moving forwards to address social determinants of health appears to be entering the mainstream in US health care. If the last decade was about health care's awakening to the realities of social determinants of health and why they matter, the next ten years will hopefully focus on how to address them as clinicians, as organizations, and as partners to the civic, public health, and social sector peers.

scholarly journals Using an Ontology to Facilitate More Accurate Coding of Social Prescriptions Addressing Social Determinants of Health: Feasibility Study

10.2196/23721 ◽  
2020 ◽  
Vol 22 (12) ◽  
pp. e23721
Author(s):  
Anant Jani ◽  
Harshana Liyanage ◽  
Cecilia Okusi ◽  
Julian Sherlock ◽  
Uy Hoang ◽  
...  
Keyword(s):  
Primary Care ◽  
Social Determinants Of Health ◽  
General Practitioners ◽  
Social Determinants ◽  
Royal College ◽  
Determinants Of Health ◽  
Social Prescribing ◽  
The Social ◽  
Care Practices ◽  
Primary Care Practices

Background National Health Service (NHS) England supports social prescribing in order to address social determinants of health, which account for approximately 80% of all health outcomes. Nevertheless, data on ongoing social prescribing activities are lacking. Although NHS England has attempted to overcome this problem by recommending 3 standardized primary care codes, these codes do not capture the social prescribing activity to a level of granularity that would allow for fair attribution of outcomes to social prescribing. Objective In this study, we explored whether an alternative approach to coding social prescribing activity, specifically through a social prescribing ontology, can be used to capture the social prescriptions used in primary care in greater detail. Methods The social prescribing ontology, implemented according to the Web Ontology Language, was designed to cover several key concepts encompassing social determinants of health. Readv2 and Clinical Terms Version 3 codes were identified using the NHS Terms Browser. The Royal College of General Practitioners Research Surveillance Centre, a sentinel network of over 1000 primary care practices across England covering a population of more than 4,000,000 registered patients, was used for data analyses for a defined period (ie, January 2011 to December 2019). Results In all, 668 codes capturing social prescriptions addressing different social determinants of health were identified for the social prescribing ontology. For the study period, social prescribing ontology codes were used 5,504,037 times by primary care practices of the Royal College of General Practitioners Research Surveillance Centre as compared to 29,606 instances of use of social prescribing codes, including NHS England’s recommended codes. Conclusions A social prescribing ontology provides a powerful alternative to the codes currently recommended by NHS England to capture detailed social prescribing activity in England. The more detailed information thus obtained will allow for explorations about whether outputs or outcomes of care delivery can be attributed to social prescriptions, which is essential for demonstrating the overall value that social prescribing can deliver to the NHS and health care systems.

scholarly journals Association of the Social Determinants of Health With Quality of Primary Care

2018 ◽  
Vol 16 (3) ◽  
pp. 217-224 ◽  
Author(s):  
Alan Katz ◽  
Dan Chateau ◽  
Jennifer E. Enns ◽  
Jeff Valdivia ◽  
Carole Taylor ◽  
...  
Keyword(s):  
Primary Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Quality Of Primary Care ◽  
The Social

scholarly journals Nutritional status of elderly assisted in primary care and their relationship with social determinants of health

2019 ◽  
Vol 32 ◽  
Author(s):  
Georgia Ferreira da Silva BANDEIRA ◽  
Rafael da Silveira MOREIRA ◽  
Vanessa de Lima SILVA
Keyword(s):  
Primary Care ◽  
Body Mass Index ◽  
Nutritional Status ◽  
Marital Status ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
The Elderly ◽  
Excess Weight ◽  
Determinants Of Health ◽  
The Social

ABSTRACT Objective To review the influence of social determinants of health in the nutritional status of the elderly assisted in a primary care Unit in a Recife, Pernambuco, Brazil, community. Methods This was a cross-sectional study with an analytical approach. The universe was composed of 129 elderly attending a family health unit in Recife, Pernambuco, Brazil. The data were collected according to a protocol. The effect of the association of independent variables with the body mass index was estimated using hierarchical logistic regression models, simple and multiple multinomial. The significance level was set at 5%. Results There was a higher percentage of elderly people with excess weight (52.34%) in the assessment of body mass index. On analysis of the Mini nutritional assessment, the risk of malnutrition was 38.76%. On analysis of the calf circumference 13.39% of the elderly were malnourished. In the final model, the criteria for maintaining the elderly patients were the following: excess weight, marital status, hypertension, osteoarthritis and sewer destination. Elderly widowers had a higher chance (OR=5.17) of having excess weight and not to have sewage network serving their home and be hypertense (OR=2.71 e 2.83). The fact that the elderly have osteoarthritis also indicated a greater chance (OR=3.76) that they present excess weight. Conclusion Among the social determinants of health, the nutritional status of the elderly was associated with marital status, high blood pressure, osteoarthritis and basic sanitation. The social setting of the elderly is associated with their nutritional status.

scholarly journals Using an Ontology to Facilitate More Accurate Coding of Social Prescriptions Addressing Social Determinants of Health: Feasibility Study (Preprint)

2020 ◽  
Author(s):  
Anant Jani ◽  
Harshana Liyanage ◽  
Cecilia Okusi ◽  
Julian Sherlock ◽  
Uy Hoang ◽  
...  
Keyword(s):  
Primary Care ◽  
Social Determinants Of Health ◽  
General Practitioners ◽  
Social Determinants ◽  
Royal College ◽  
Determinants Of Health ◽  
Social Prescribing ◽  
The Social ◽  
Care Practices ◽  
Primary Care Practices

BACKGROUND National Health Service (NHS) England supports social prescribing in order to address social determinants of health, which account for approximately 80% of all health outcomes. Nevertheless, data on ongoing social prescribing activities are lacking. Although NHS England has attempted to overcome this problem by recommending 3 standardized primary care codes, these codes do not capture the social prescribing activity to a level of granularity that would allow for fair attribution of outcomes to social prescribing. OBJECTIVE In this study, we explored whether an alternative approach to coding social prescribing activity, specifically through a social prescribing ontology, can be used to capture the social prescriptions used in primary care in greater detail. METHODS The social prescribing ontology, implemented according to the Web Ontology Language, was designed to cover several key concepts encompassing social determinants of health. Readv2 and Clinical Terms Version 3 codes were identified using the NHS Terms Browser. The Royal College of General Practitioners Research Surveillance Centre, a sentinel network of over 1000 primary care practices across England covering a population of more than 4,000,000 registered patients, was used for data analyses for a defined period (ie, January 2011 to December 2019). RESULTS In all, 668 codes capturing social prescriptions addressing different social determinants of health were identified for the social prescribing ontology. For the study period, social prescribing ontology codes were used 5,504,037 times by primary care practices of the Royal College of General Practitioners Research Surveillance Centre as compared to 29,606 instances of use of social prescribing codes, including NHS England’s recommended codes. CONCLUSIONS A social prescribing ontology provides a powerful alternative to the codes currently recommended by NHS England to capture detailed social prescribing activity in England. The more detailed information thus obtained will allow for explorations about whether outputs or outcomes of care delivery can be attributed to social prescriptions, which is essential for demonstrating the overall value that social prescribing can deliver to the NHS and health care systems.

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