Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Popul Health Manag. 2022 Jun;25(3):367-374. doi: 10.1089/pop.2021.0176. Epub 2021 Oct 25.
Social determinants of health (SDH) contribute to nearly 50% of health outcomes; however, SDH data collection is inconsistent in clinical practice. This study used mixed methods to evaluate health care professionals' perceptions of universal SDH screening at an academic medical center by surveying physicians, advanced practice providers, nurses, social workers, case managers, pharmacists, and administrators. An electronic survey assessed SDH screening practices, prioritization of SDH domains, disciplines to perform screening, and attitudes and barriers to universal screening. Likert-scale responses were dichotomized and compared disciplines with proportions tests. Qualitative interviews identified themes and elaborated survey findings. Participant discipline was the primary predictor variable. Of 193 survey participants (62.5% response rate), most were physicians (31%) or social workers (22%). Participants overwhelmingly reported using SDH information in patient care (93%), and social workers as the most appropriate role for screening (95%). Most respondents (75%) believed health literacy is important, but 40% reported routine assessment. Housing status (73% vs. 53%) and financial strain (62% vs. 48%) followed similar patterns. SDH screening barriers included lacking resources to address identified needs (51%), time to ask (45%), support staff to ask (33%), and training in responding to identified needs (28%). Social workers cited barriers less often than non-social workers ( < 0.001). Qualitative interviews (n = 16) supported survey findings and described barriers including lack of time, resources, standardized approaches, and professional burnout. Health care professionals support universal SDH screening while highlighting the need to address implementation barriers. Strategies should leverage social work expertise and optimize SDH data accessibility for all providers.
社会决定因素健康 (SDH) 对近 50%的健康结果有影响；然而，SDH 数据的收集在临床实践中并不一致。本研究采用混合方法，通过调查医生、高级执业医师、护士、社会工作者、个案管理员、药剂师和管理人员，评估学术医疗中心内医疗保健专业人员对普遍 SDH 筛查的看法。电子调查评估了 SDH 筛查实践、SDH 领域的优先级、进行筛查的学科，以及对普遍筛查的态度和障碍。李克特量表的反应被二值化，并通过比例检验比较了学科。定性访谈确定了主题并阐述了调查结果。参与者的学科是主要的预测变量。在 193 名调查参与者中（62.5%的回复率），大多数是医生（31%）或社会工作者（22%）。参与者压倒性地报告说在患者护理中使用 SDH 信息（93%），并且社会工作者是最适合进行筛查的角色（95%）。大多数受访者（75%）认为健康素养很重要，但 40%的人报告了常规评估。住房状况（73%比 53%）和经济压力（62%比 48%）也呈现类似模式。SDH 筛查障碍包括缺乏解决已确定需求的资源（51%）、询问的时间（45%）、询问的支持人员（33%）和应对已确定需求的培训（28%）。社会工作者比非社会工作者较少提到障碍（<0.001）。定性访谈（n=16）支持调查结果，并描述了障碍，包括缺乏时间、资源、标准化方法和职业倦怠。医疗保健专业人员支持普遍的 SDH 筛查，同时强调需要解决实施障碍。策略应利用社会工作专业知识，并优化所有提供者的 SDH 数据可及性。
