在初级保健中解决与健康相关的社会需求的鉴定后方法：一项定性研究。
Post-Identification Approaches to Addressing Health-Related Social Needs in Primary Care: A Qualitative Study.
机构信息
University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA.
Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA.
出版信息
J Gen Intern Med. 2022 Mar;37(4):802-808. doi: 10.1007/s11606-021-07033-8. Epub 2021 Jul 30.
BACKGROUND
Social determinants of health play a fundamental role in a patient's health status. In recent years, health systems across the nation have implemented numerous strategies aimed at identifying and addressing the health-related social needs of the patients they serve. Despite the influx of peer-reviewed research highlighting outcomes of specific health-related social needs interventions, the spectrum of practices utilized by primary care clinics has not been established.
OBJECTIVE
To determine the range of ways primary care clinics address health-related social needs after identification and initial contact with a frontline staff person is completed.
DESIGN
We conducted 12 semi-structured, in-person interviews with staff from purposively sampled clinics. If the interview included more than one staff person, all participants were interviewed together.
PARTICIPANTS
Twenty-one administrative staff and frontline clinic personnel with experience in 24 separate primary care clinics in the Minneapolis-St. Paul, Minnesota metropolitan area.
APPROACH
Interviews focused on the range of health-related social needs processes utilized by clinics, including staff titles, referral procedures, and barriers to addressing needs. Interview recordings were transcribed and coded using thematic analysis.
KEY RESULTS
Thematic analysis identified variation in four key areas involving how clinics address patients' health-related social needs after identification and initial contact by frontline staff: clinic personnel involved in addressing needs, clinic referral processes, "resource" and "success" definitions, and barriers to accessing community-based supports.
CONCLUSIONS
This study describes the large variation in primary care clinic practices to address health-related social needs after they are identified. The results suggest challenges to standardization and real-world application of previously published studies. Our findings also highlight the opportunity for improved relationships between health systems and community-based agencies.
背景
健康的社会决定因素对患者的健康状况起着根本作用。近年来，全国的卫生系统实施了许多策略，旨在确定和解决所服务患者的与健康相关的社会需求。尽管有大量同行评议的研究强调了特定与健康相关的社会需求干预措施的结果，但基层诊所使用的实践范围尚未确定。
目的
确定基层诊所在与一线工作人员完成初步接触和识别与健康相关的社会需求后，解决与健康相关的社会需求的方式范围。
设计
我们对明尼苏达州明尼阿波利斯-圣保罗大都市区 24 家基层诊所的工作人员进行了 12 次半结构式现场访谈。如果访谈包括多名工作人员，则所有参与者一起接受访谈。
参与者
21 名行政人员和具有 24 家基层诊所经验的一线诊所人员。
方法
访谈重点关注诊所使用的与健康相关的社会需求流程范围，包括工作人员的职称、转介程序以及解决需求的障碍。采访录音使用主题分析进行转录和编码。
主要结果
主题分析确定了四个关键领域的变化，这些领域涉及诊所如何在一线工作人员识别和初步接触后解决患者的与健康相关的社会需求：参与解决需求的诊所人员、诊所转介程序、“资源”和“成功”的定义以及获取社区支持的障碍。
结论
本研究描述了基层诊所在识别与健康相关的社会需求后解决这些需求的实践的巨大差异。结果表明，在标准化和实际应用以前发表的研究方面存在挑战。我们的研究结果还突出了改善卫生系统和社区机构之间关系的机会。
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