scholarly journals Health Related Social Needs Among Chinese American Primary Care Patients During the COVID-19 Pandemic: Implications for Cancer Screening and Primary Care

2021 ◽  
Vol 9 ◽  
Author(s):  
Jennifer Tsui ◽  
Annie Yang ◽  
Bianca Anuforo ◽  
Jolene Chou ◽  
Ruth Brogden ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Screening ◽  
Food Insecurity ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Interpersonal Violence ◽  
Social Needs ◽  
Housing Instability ◽  
Health Related ◽  
Primary Care Patients

Research Objective: Initiatives to address social determinants of health (SDOH) and measure health-related social needs (HRSN) within clinic settings are increasing. However, few have focused on the specific needs of Asian Americans (AA). We examine the prevalence of HRSN during a period spanning the COVID-19 pandemic to inform strategies to improve cancer screening and primary care among AA patients.Methods: We implemented a self-administered HRSN screening tool in English and Chinese, traditional (T) or simplified (S) text, within a hospital-affiliated, outpatient primary care practice predominantly serving AA in New Jersey. HRSN items included food insecurity, transportation barriers, utility needs, interpersonal violence, housing instability, immigration history, and neighborhood perceptions on cohesion and trust. We conducted medical chart reviews for a subset of participants to explore the relationship between HRSN and history of cancer screening.Results: Among 236 participants, most were Asian (74%), non-US born (79%), and privately insured (57%). One-third responded in Chinese (37%). Half reported having ≥1 HRSN. Interpersonal violence was high across all participants. Transportation needs were highest among Chinese-T participants, while food insecurity and housing instability were higher among Chinese-S participants. Lower-income patients had higher odds of having ≥2 HRSN (OR:2.53, 95% CI: 1.12, 5.98). Older age and public insurance/uninsured were significantly associated with low neighborhood perceptions.Conclusions: We observed higher than anticipated reports of HRSN among primary care patients in a suburban, hospital-affiliated practice serving AA. Low neighborhood perceptions, particularly among Chinese-S participants, highlight the importance of addressing broader SDOH among insured, suburban AA patients. These study findings inform the need to augment HRSN identification to adequately address social needs that impact health outcomes and life course experiences for Asian patients. As HRSN measuring efforts continue, and COVID-19's impact on the health of minority communities emerge, it will be critical to develop community-specific referral pathways to connect AA to resources for HRSN and continue to address more upstream social determinants of health for those who are disproportionately impacted.

scholarly journals Association of Home Based Primary Care Enrollment with Social Determinants of Health for Older Veterans

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 918-919
Author(s):  
Anna-Rae Montano ◽  
Augustus Ge ◽  
Christopher Halladay ◽  
Samuel Edwards ◽  
James Rudolph ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Health Outcomes ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Needs ◽  
Determinants Of Health ◽  
Home Based Primary Care ◽  
Home Based ◽  
High Deprivation

Abstract The Veterans Administration (VA) Home-based Primary Care (HBPC) program provides comprehensive primary care to older Veterans with multiple chronic conditions who may be at risk of adverse health outcomes due to their social determinants of health. Area Deprivation Index (ADI) can be used as a surrogate measure of a Veteran’s social needs. The objective of this study was to estimate the effect of neighborhood disadvantage, as measured by ADI, on HBPC enrollment for a sample of older Veterans. We estimated a linear multivariate model in which the exposure was ADI and the outcome was enrollment in HBPC. Controls included clinical and demographic characteristics. In a final sample of 12,005,453 observations (total Veteran months) on 353,485 individual Veterans, 18.4% lived in high-deprivation neighborhoods (ADI greater than or equal to 80). Mean monthly probability of new HBPC enrollment was 0.0061. Controlling for clinical characteristics, housing instability, and distance from the medical center, Veterans residing in high-deprivation neighborhoods were 1.4% to 14.8% less likely to enroll in HBPC, though the association was not statistically significant. The VA HBPC program provides beneficial comprehensive, primary care services to Veterans at risk of poor health outcomes. However, a Veteran’s social determinants of health could prevent enrollment. More research is needed to determine the relationship between Veterans’ social needs and HBPC enrollment.

scholarly journals Implementation process of social prescribing to improve primary care patients’ health and well-being

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
S Dias ◽  
C Figueiredo ◽  
A Coelho ◽  
L Hoffmeister ◽  
A Gama
Keyword(s):  
Primary Care ◽  
Social Determinants Of Health ◽  
Social Workers ◽  
Social Determinants ◽  
Implementation Process ◽  
Skills Training ◽  
Well Being ◽  
Determinants Of Health ◽  
Social Prescribing ◽  
Primary Care Patients

Abstract Social prescribing (SP) is an innovative approach to tackle social determinants of health. It enables general practitioners (GPs) to address non-medical causes of ill-health by linking primary care patients with non-medical community sources of support. Despite convincing results from punctual evaluations, comprehensive evaluation of SP is needed to provide guidance on what works and evidence on its impact. A SP pilot-project started in 2018 in a primary care service in Lisbon. Its implementation process and outcomes are being evaluated through a longitudinal mixed-method evaluation study assessing patients’ wellbeing, quality of life, anxiety and depression in key stages of the intervention and stakeholders’ perspectives on facilitators/barriers to the intervention implementation. GPs refer patients to a social worker of the service, who defines with the patient the individual intervention plan using community resources. Initially, GPs and social workers were trained on SP, a network of community partners was built, SP information was distributed to patients, a referral online platform was created and a baseline study is being conducted. In the 1st semester, 130 patients were referred: 39.2% were ≥65 years old, 70.8% were female, 45.4% had foreign nationality. Over two thirds were referred for multiple reasons mostly social isolation, immigration/social integration, mental health, sedentary lifestyle, access to social benefits and employment/skills training. The project has enabling to support patients with multiple complex psychosocial needs. Regular meetings between GPs and partners have improving collaboration and patients’ supervision. The participatory approach and training emerged as facilitators of the intervention. Yet, the increased burden on social workers due to growing referral profile and some stakeholders’ scepticism toward SP need to be addressed. The triangulation of sources, methods and data provide evidence on the intervention impact and scalability. Key messages The social prescribing intervention has been effective in tackling multiple social determinants of health. Intervention evaluation is being key to identify facilitators and opportunities for scale up.

Health-Related Outcomes Associated with Patterns of Risk Factors in Primary Care Patients

2013 ◽  
Vol 21 (1) ◽  
pp. 10-18
Author(s):  
Jennifer S. Funderburk ◽  
Stephen A. Maisto ◽  
Allison K. Labbe
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Health Related ◽  
Primary Care Patients

scholarly journals Exploring the association of social determinants of health and clinical quality measures and performance in HRSA-funded health centres

2021 ◽  
Vol 9 (3) ◽  
pp. e000853
Author(s):  
Michael Topmiller ◽  
Jessica McCann ◽  
Jennifer Rankin ◽  
Hank Hoang ◽  
Joshua Bolton ◽  
...  
Keyword(s):  
Cancer Screening ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Deprivation ◽  
Health Centre ◽  
Quality Measures ◽  
Service Area ◽  
Determinants Of Health ◽  
Clinical Quality ◽  
Health Centres

ObjectiveThis paper explores the impact of service area-level social deprivation on health centre clinical quality measures.DesignCross-sectional data analysis of Health Resources and Services Administration (HRSA)-funded health centres. We created a weighted service area social deprivation score for HRSA-funded health centres as a proxy measure for social determinants of health, and then explored adjusted and unadjusted clinical quality measures by weighted service area Social Deprivation Index quartiles for health centres.SettingsHRSA-funded health centres in the USA.ParticipantsOur analysis included a subset of 1161 HRSA-funded health centres serving more than 22 million mostly low-income patients across the country.ResultsHigher levels of social deprivation are associated with statistically significant poorer outcomes for all clinical quality outcome measures (both unadjusted and adjusted), including rates of blood pressure control, uncontrolled diabetes and low birth weight. The adjusted and unadjusted results are mixed for clinical quality process measures as higher levels of social deprivation are associated with better quality for some measures including cervical cancer screening and child immunisation status but worse quality for other such as colorectal cancer screening and early entry into prenatal care.ConclusionsThis research highlights the importance of incorporating community characteristics when evaluating clinical outcomes. We also present an innovative method for capturing health centre service area-level social deprivation and exploring its relationship to health centre clinical quality measures.

scholarly journals Pushing poverty off limits: quality improvement and the architecture of healthcare values

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Polly Mitchell ◽  
Alan Cribb ◽  
Vikki Entwistle ◽  
Guddi Singh
Keyword(s):  
Quality Improvement ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Deprivation ◽  
Ethical Dilemmas ◽  
Determinants Of Health ◽  
Ethical Challenges ◽  
The Social ◽  
Significant Burden ◽  
Health Related

Abstract Background Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people’s lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative (PSI) into paediatric practice using the discourse and methodology of healthcare quality improvement (QI). Discussion Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty ‘off limits.’ We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health. Conclusions We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods.

Hunger: A Missed Opportunity for Screening in the Pediatric Emergency Department

2018 ◽  
Vol 57 (11) ◽  
pp. 1318-1325 ◽  
Author(s):  
Tamar Robinson ◽  
Leah Bryan ◽  
Veda Johnson ◽  
Terri McFadden ◽  
Sarah Lazarus ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Emergency Department ◽  
Food Insecurity ◽  
Hospital Staff ◽  
Social Needs ◽  
Social Risk ◽  
Care Hospital ◽  
Social Risk Factors ◽  
Primary Care Hospital

Background. The American Academy of Pediatrics and pediatric community recognize the importance of addressing social determinants of health. There are limited data on the prevalence of food insecurity or literature establishing protocols assessing food insecurity in the emergency department (ED). Methods. Two anonymous surveys were administered, one to families during their ED visit and another to ED staff to assess perceptions on the ED’s role in providing social support. Results. Thirty-three of 214 respondents (15.4%) reported food insecurity and are associated with economic risk factors ( P < .0001) and a lack of primary care ( P = .008). Overall, 83.2% of the ED staff believed knowing information about families’ social risk factors would help patient care and 77.6% believed that the ED staff should address families’ social needs. Conclusions. Food insecurity affects a significant portion of ED families across income ranges. Screening for food insecurity in the ED is important given association with lack of primary care. Hospital staff supports screening and intervention.

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