Aery Anjana, Rucchetto Anne, Singer Alexander, Halas Gayle, Bloch Gary, Goel Ritika, Raza Danyaal, Upshur Ross E G, Bellaire Jackie, Katz Alan, Pinto Andrew David
Wellesley Institute, Toronto, Ontario, Canada.
The Upstream Lab, Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
BMJ Open. 2017 Oct 22;7(10):e015947. doi: 10.1136/bmjopen-2017-015947.
Addressing 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?
An 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.
Key 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.
Clinicaltrials.gov: NCT02959866. Registered 7 November 2016. Retrospectively registered. Pre-results.
解决健康的社会决定因素已被视为减少健康不平等的关键。然而，基于证据的干预措施却很少。本研究源于医生、研究人员与一个金融知识普及组织之间正在进行的合作。我们的研究将回答以下问题：一个能改善获取经济福利机会的在线工具是否可行且可接受？这样的工具能否整合到临床工作流程中？患者对该工具的看法如何，以及它对获取福利的短期影响是什么？
一个由低收入患者和社区机构代表组成的咨询小组为这项研究提供支持。我们将在安大略省多伦多市招募三个为低收入社区服务的初级保健机构，在曼尼托巴省温尼伯市也招募三个。我们将向临床医生介绍贫困筛查以及福利如何增加收入。鼓励医疗服务提供者在诊治任何患者时使用该工具。医疗服务提供者和患者将共同完成在线工具，生成一份量身定制的福利和资源清单，以协助获取这些福利。在患者完成工具后，将对其进行一次关于此次体验的简短调查，并要求在1个月后联系他们。那些同意被联系的患者将接受访谈，询问干预措施是否改善了获取经济福利的机会。我们还将对提供者进行在线调查，并在每个地点开展焦点小组讨论。
关键的伦理问题包括，当被问及财务状况时患者可能会感到不适，可能会觉得有义务完成工具，以及可能会对获得福利产生不切实际的期望。将对提供者进行培训，以解决这些问题。我们将与有兴趣在医疗环境中解决健康社会决定因素的提供者和政策制定者分享我们的研究结果。
Clinicaltrials.gov：NCT02959866。于2016年11月7日注册。追溯注册。预结果。
