From Trinity College of Arts & Sciences, Duke University, Durham, NC (SS, TL, LS); Duke-Margolis Center for Health Policy, Duke University, Durham, NC (SS, JPB); Harvard Medical School, Boston, MA (SS); Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (TL); Penn State College of Medicine, Hershey, PA (LS); Department of Population Health Sciences, Duke University School of Medicine, Durham, NC (CD); Lincoln Community Health Center, Durham, NC and Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC (HE); Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC (JPB).
J Am Board Fam Med. 2022 Jul-Aug;35(4):793-802. doi: 10.3122/jabfm.2022.04.210462.
Many primary care clinics screen patients for their unmet social needs, such as food insecurity and housing instability, and refer them to community-based organizations (CBOs). However, the ability for patients to have their needs met is difficult to evaluate and address. This study explores patient-reported barriers to accessing referred resources using a conceptual framework that identifies opportunities for intervening to optimize success.
Patients who participated in a social needs screening and referral intervention at a Federally Qualified Health Center (FQHC) were called 2 weeks after the clinic encounter. We conducted a directed content analysis across 6 domains of access to examine responses from patients who reported barriers.
Of the 462 patients that were reached for follow-up, 366 patients reported 537 total barriers. The most frequent challenges related to resource availability (24.6%, eg, patients waiting for submitted application to process) and approachability (23.8%, eg, patients lacking information needed to contact or access resources). Barriers in the domains of acceptability (21.6%, eg, competing life priorities such as medical issues, major life events, or caretaking responsibilities) and appropriateness (17.9%, eg, resource no longer needed) largely represented patient constraints expressed only after the clinical encounter. It was less common for patients to identify accommodation (eg, physical limitations, language barriers, transportation barriers, administrative complexity) or affordability of community resources as barriers (11.2% and 0.9%, respectively).
Findings suggest opportunities for improvement across the access continuum, from initial referrals from primary care staff during the clinical encounter to patients' attempts to accessing services in the community. Future efforts should consider increased collaboration between health and social service organizations, and advocacy for structural changes that mitigate system-level barriers related to resource availability and administrative complexity.
许多基层医疗诊所对患者进行未满足的社会需求筛查，例如食物无保障和住房不稳定，并将他们转介到社区组织 (CBO)。然而，患者满足需求的能力很难评估和解决。本研究使用一个概念框架探索了患者报告的获取转介资源障碍，该框架确定了进行干预以优化成功的机会。
在一家合格的联邦健康中心 (FQHC) 进行社会需求筛查和转介干预后，对参与患者进行了 2 周的诊所随访。我们对获取的 6 个领域进行了定向内容分析，以检查报告存在障碍的患者的反应。
在联系到的 462 名患者中，有 366 名患者报告了 537 项总障碍。最常见的挑战与资源可用性有关（24.6%，例如，患者等待提交的申请处理）和可及性（23.8%，例如，患者缺乏联系或获取资源所需的信息）。可接受性领域（21.6%，例如，与医疗问题、重大生活事件或照顾责任等生活优先事项竞争）和适当性领域（17.9%，例如，资源不再需要）的障碍主要代表患者在临床接触后表达的限制。患者很少将住宿（例如，身体限制、语言障碍、交通障碍、行政复杂性）或社区资源的负担能力（分别为 11.2%和 0.9%）视为障碍。
研究结果表明，从临床接触期间初级保健人员最初的转介到患者在社区中尝试获取服务，整个获取过程都有改进的机会。未来的努力应考虑加强卫生和社会服务组织之间的合作，并倡导进行结构改革，以减轻与资源可用性和行政复杂性相关的系统层面障碍。
