Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Int J Equity Health. 2019 Jul 23;18(1):112. doi: 10.1186/s12939-019-1014-2.
People's social and economic circumstances are important determinants of their health, health experiences, healthcare access, and healthcare outcomes. However, patients' socioeconomic circumstances are rarely asked about or documented in healthcare settings. We conducted a systematic review of published reasons for why patients' socioeconomic contexts (including education, employment, occupation, housing, income, or wealth) should, or should not, be enquired about.
Systematic review of literature published up to and including 2016. A structured literature search using databases of medicine and nursing (pubmed, embase, global health), ethics (Ethicsweb), social sciences (Web of Science), and psychology (PsychINFO) was followed by a 'snowball' search. Eligible publications contained one or more reasons for: asking patients about socioeconomic circumstances; collecting patients' socioeconomic information; 'screening' patients for adverse socioeconomic circumstances; or linking other sources of individual socioeconomic data to patients' healthcare records. Two authors conducted the screening: the first screened all references, the second author screened a 20% sample with inter-rater reliability statistically confirmed. 'Reason data' was extracted from eligible publications by two authors, then analysed and organised.
We identified 138 eligible publications. Most offered reasons for why patients' should be asked about their socioeconomic circumstances. Reasons included potential improvements in: individual healthcare outcomes; healthcare service monitoring and provision; population health research and policies. Many authors also expressed concerns for improving equity in health. Eight publications suggested patients should not be asked about their socioeconomic circumstances, due to: potential harms; professional boundaries; and the information obtained being inaccurate or unnecessary.
This first summary of literature on the subject found many published reasons for why patients' social and economic circumstances should be enquired about in healthcare settings. These reasons include potential benefits at the levels of individuals, health service provision, and population, as well as the potential to improve healthcare equity. Cautions and caveats include concerns about the clinician's role in responding to patients' social problems; the perceived importance of social health determinants compared with biomedical factors; the use of average population data from geographic areas to infer the socioeconomic experience of individuals. Actual evidence of outcomes is lacking: our review suggests hypotheses that can be tested in future research.
人们的社会经济状况是影响其健康、健康体验、医疗保健获取和医疗保健结果的重要决定因素。然而，患者的社会经济状况在医疗保健环境中很少被询问或记录。我们对已发表的关于为何应询问患者的社会经济背景（包括教育、就业、职业、住房、收入或财富）或不应询问患者的社会经济背景的原因进行了系统评价。
对截至 2016 年发表的文献进行系统评价。使用医学和护理数据库（pubmed、embase、全球健康）、伦理学数据库（Ethicsweb）、社会科学数据库（Web of Science）和心理学数据库（PsychINFO）进行结构化文献检索，然后进行“滚雪球”搜索。符合条件的出版物包含一个或多个询问患者社会经济状况、收集患者社会经济信息、对患者进行不利社会经济状况“筛查”或将其他来源的个人社会经济数据与患者的医疗记录相链接的原因。两位作者进行筛选：第一位作者筛选所有参考文献，第二位作者对经过统计学确认的 20%的样本进行筛选。两位作者从合格出版物中提取“原因数据”，然后进行分析和整理。
我们确定了 138 篇合格的出版物。大多数出版物都提供了询问患者社会经济状况的原因，包括可能改善个人医疗保健结果、医疗服务监测和提供、人口健康研究和政策。许多作者还表示关注改善健康公平。8 篇出版物建议不要询问患者的社会经济状况，原因包括潜在危害、专业界限以及所获得的信息不准确或不必要。
这是对该主题文献的首次总结，发现了许多在医疗保健环境中询问患者社会和经济状况的原因，这些原因包括个人、医疗服务提供和人群水平的潜在益处，以及改善医疗保健公平的潜力。需要注意的是，包括对临床医生在应对患者社会问题中的作用的担忧、社会健康决定因素相对于生物医学因素的相对重要性、使用地理区域的平均人群数据推断个体的社会经济体验。缺乏实际结果证据：我们的综述提出了可以在未来研究中检验的假设。
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