Herrera Carolina-Nicole, Brochier Annelise, Pellicer Michelle, Garg Arvin, Drainoni Mari-Lynn
Boston University School of Public Health, Boston, MA, USA.
Boston Medical Center, Boston, MA, USA.
J Prim Care Community Health. 2019 Jan-Dec;10:2150132719887260. doi: 10.1177/2150132719887260.
Screening for social determinants of health (SDOH) during primary care office visits is recommended by pediatric and internal medicine professional guidelines. Less is known about how SDOH screening and service referral can be successfully integrated into clinical practice. Key informant interviews with 11 community health center (CHC) clinicians and staff members (medical assistants and case managers) were analyzed to identify themes related to integrating a SDOH screening and referral process (augmented WE CARE model) into their workflow. CHC clinicians and staff believed the augmented WE CARE model benefited their patients and the CHC's mission. Most clinicians found the model was easy to implement. Some staff members had difficulty prioritizing the nonclinical intervention and were confused about their roles and the role of the patient navigator. The eligibility requirements and time needed to access local SDOH resources frustrated clinicians. SDOH screening and referral care models can help support the mission of CHCs by identifying unmet material needs. However, CHCs have organizational and administrative challenges that successful interventions must address. CHCs need clinical champions for SDOH models because the screening and follow-up processes involve clinical staff. Additional support for SDOH models might include piloting the SDOH screening model workflow and formalizing the workflow before implementation, including the specific roles for clinicians, staff, and patient navigators.
儿科和内科专业指南建议在初级保健门诊就诊期间对健康的社会决定因素（SDOH）进行筛查。关于如何将SDOH筛查和服务转诊成功整合到临床实践中，人们了解得较少。对11名社区卫生中心（CHC）的临床医生和工作人员（医疗助理和病例管理人员）进行了关键信息访谈，以确定与将SDOH筛查和转诊流程（增强型WE CARE模型）整合到他们的工作流程相关的主题。CHC的临床医生和工作人员认为增强型WE CARE模型有利于他们的患者和CHC的使命。大多数临床医生发现该模型易于实施。一些工作人员在确定非临床干预的优先级方面存在困难，并且对他们自己的角色以及患者导航员的角色感到困惑。获取当地SDOH资源的资格要求和所需时间让临床医生感到沮丧。SDOH筛查和转诊护理模型可以通过识别未满足的物质需求来帮助支持CHC的使命。然而，CHC存在组织和行政方面的挑战，成功的干预措施必须加以解决。CHC需要SDOH模型的临床倡导者，因为筛查和后续流程涉及临床工作人员。对SDOH模型的额外支持可能包括试行SDOH筛查模型工作流程，并在实施前将工作流程正规化，包括临床医生、工作人员和患者导航员的具体角色。
