School of Public Health, San Diego State University, 5500 Campanile Drive, 92182, San Diego, CA, USA.
Department of Family & Community Medicine, University of California, San Francisco, 995 Potrero Ave, 94110, San Francisco, CA, USA.
BMC Health Serv Res. 2023 Mar 13;23(1):246. doi: 10.1186/s12913-023-09214-z.
Evidence on the health impacts of social conditions has led US healthcare systems to consider identifying and addressing social adversity-e.g. food, housing, and transportation insecurity-in care delivery settings. Social screening is one strategy being used to gather patient information about social circumstances at the point of care. While several recent studies describe the rapid proliferation of social screening activities, little work has explored either why or how to implement social screening in clinical settings. Our study objectives were to assess diverse healthcare stakeholder perspectives on both the rationale for social screening and evidence needed to inform practice and policy-relevant implementation decisions.
We convened five focus groups with US experts representing different stakeholder groups: patient advocates, community-based organizations, healthcare professionals, payers, and policymakers. In total, 39 experts participated in approximately 90-minute long focus groups conducted between January-March 2021. A inductive thematic analysis approach was used to analyze discussions.
Three themes emerged from focus groups, each reflecting the tension between the national enthusiasm for screening and existing evidence on the effectiveness and implementation of screening in clinical settings: (1) ambiguity about the rationale for social screening; (2) concerns about the relavence of screening tools and approaches, particularly for historically marginalized populations; (3) lack of clarity around the resources needed for implementation and scaling.
While participants across groups described potential benefits of social screening, they also highlighted knowledge gaps that interfered with realizing these benefits. Efforts to minimize and ideally resolve these knowledge gaps will advance future social screening practice and policy.
有关社会条件对健康影响的证据促使美国医疗保健系统考虑在医疗服务环境中识别和解决社会逆境，例如食品、住房和交通不安全问题。社会筛查是一种在医疗保健点收集患者社会环境信息的策略。尽管最近有几项研究描述了社会筛查活动的迅速普及，但很少有工作探讨在临床环境中实施社会筛查的原因或方法。我们的研究目的是评估不同医疗保健利益相关者对社会筛查的基本原理以及为实践和政策相关实施决策提供信息所需证据的看法。
我们召集了五组美国专家参加焦点小组会议，这些专家代表不同的利益相关者群体：患者权益倡导者、社区组织、医疗保健专业人员、支付方和政策制定者。共有 39 名专家参加了 2021 年 1 月至 3 月期间举行的大约 90 分钟的焦点小组会议。采用归纳主题分析方法对讨论进行分析。
焦点小组会议产生了三个主题，每个主题都反映了国家对筛查的热情与临床环境中筛查的有效性和实施的现有证据之间的紧张关系：（1）社会筛查的基本原理不明确；（2）对筛查工具和方法的相关性的担忧，特别是对历史上处于边缘地位的人群；（3）对实施和扩大规模所需资源的认识不清。
尽管各个群体的参与者都描述了社会筛查的潜在好处，但他们也强调了干扰实现这些好处的知识差距。努力最小化并理想地解决这些知识差距将推动未来的社会筛查实践和政策。
