Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Greenville.
Department of Medicine, Prisma Health, Upstate, University of South Carolina School of Medicine Greenville, Greenville.
JAMA Netw Open. 2023 Nov 1;6(11):e2345444. doi: 10.1001/jamanetworkopen.2023.45444.
Health systems in the US are increasingly screening for social determinants of health (SDOH). However, guidance incorporating stakeholder feedback is limited.
To examine patient and care team experiences in early implementation of SDOH screening in primary care.
DESIGN, SETTING, AND PARTICIPANTS: This qualitative study included cross-sectional analysis of SDOH screenings during primary care visits from February 22 to May 10, 2022, primary care team member interviews from July 6, 2022, to March 8, 2023, and patient stakeholder engagement on June 30, 2022. The setting was a large southeastern US health care system. Eligible patients were aged 18 years or older with completed visits in primary care.
Screening for SDOH in primary care.
Multivariable logistic regression evaluated patient (eg, age, race and ethnicity) and care team characteristics (eg, practice type), and screening completeness. Interviews contextualized the quantitative analysis.
There were 78 928 visits in practices conducting any SDOH screening. The population with visits had a mean (SD) age of 57.6 (18.1) years; 48 086 (60.9%) were female, 12 569 (15.9%) Black, 60 578 (76.8%) White, and 3088 (3.9%) Hispanic. A total of 54 611 visits (69.2%) were with a doctor of medicine and 13 035 (16.5%) with a nurse practitioner. Most had no SDOH questions answered (75 298 [95.4%]) followed by all questions (2976 [3.77%]). Logistic regression analysis found that clinician type, patient race, and primary payer were associated with screening likelihood: for clinician type, nurse practitioner (odds ratio [OR], 0.13; 95% CI, 0.03-0.62; P = .01) and physician assistant (OR, 3.11; 95% CI, 1.19-8.10; P = .02); for patient race, Asian (OR, 1.69; 95% CI, 1.25-2.28; P = .001); Black (OR, 1.49; 95% CI, 1.10-2.01; P = .009); or 2 or more races (OR, 1.48; 95% CI, 1.12-1.94; P = .006); and for primary payer, Medicaid (OR, 0.62; 95% CI, 0.48-0.80; P < .001); managed care (OR, 1.17; 95% CI, 1.07-1.29; P = .001); uninsured or with Access Health (OR, 0.26; 95% CI, 0.10-0.67; P = .005), and Tricare (OR, 0.71; 95% CI, 0.55-0.92; P = .01). Interview themes included barriers (patient hesitancy, time and resources for screening and referrals, and number of questions/content overlap) and facilitators (communication, practice champions, and support for patient needs).
This qualitative study presents potential guidance regarding factors that could improve SDOH screening within busy clinical workflows.
美国的卫生系统越来越重视健康决定因素（social determinants of health，SDOH）的筛查。然而，纳入利益相关者反馈的指导意见有限。
研究在初级保健中早期实施 SDOH 筛查时患者和护理团队的体验。
设计、地点和参与者：这是一项定性研究，包括 2022 年 2 月 22 日至 5 月 10 日期间在初级保健就诊期间进行的 SDOH 筛查的横断面分析、2022 年 7 月 6 日至 2023 年 3 月 8 日期间的初级保健团队成员访谈以及 2022 年 6 月 30 日的患者利益相关者参与。该研究地点是美国东南部的一个大型医疗保健系统。合格的患者为年龄在 18 岁或以上、已完成初级保健就诊的患者。
初级保健中的 SDOH 筛查。
多变量逻辑回归评估了患者（例如，年龄、种族和民族）和护理团队特征（例如，实践类型）以及筛查的完整性。访谈使定量分析背景化。
在开展任何 SDOH 筛查的实践中，共有 78928 次就诊。就诊人群的平均（SD）年龄为 57.6（18.1）岁；48086 名（60.9%）为女性，12569 名（15.9%）为黑人，60578 名（76.8%）为白人，3088 名（3.9%）为西班牙裔。大多数就诊者没有回答任何 SDOH 问题（75298 例[95.4%]），其次是所有问题（2976 例[3.77%]）。逻辑回归分析发现，临床医生类型、患者种族和主要支付方与筛查的可能性相关：对于临床医生类型，护士从业者（比值比[OR]，0.13；95%置信区间[CI]，0.03-0.62；P=0.01）和医师助理（OR，3.11；95%CI，1.19-8.10；P=0.02）；对于患者种族，亚洲人（OR，1.69；95%CI，1.25-2.28；P=0.001）；黑人（OR，1.49；95%CI，1.10-2.01；P=0.009）；或两种或两种以上种族（OR，1.48；95%CI，1.12-1.94；P=0.006）；对于主要支付方，医疗补助（OR，0.62；95%CI，0.48-0.80；P<0.001）；管理式医疗（OR，1.17；95%CI，1.07-1.29；P=0.001）；无保险或拥有 Access Health（OR，0.26；95%CI，0.10-0.67；P=0.005），以及 Tricare（OR，0.71；95%CI，0.55-0.92；P=0.01）。访谈主题包括障碍（患者犹豫、筛查和转介的时间和资源，以及问题数量/内容重叠）和促进因素（沟通、实践冠军和对患者需求的支持）。
这项定性研究提供了潜在的指导意见，说明在繁忙的临床工作流程中可以采取哪些措施来改善 SDOH 筛查。
