By Sara Heath
- Patients who hear about different options for social services referrals before social determinants of health (SDOH) screening are more likely to be accepting of that assistance than those who don’t, according to a study published in JAMA Network Open.
This finding, among others regarding patient receptiveness to social services referrals, may influence how providers conducting SDOH screening moving forward.
As a part of healthcare’s overall transition to value-based care, an increasing number of providers have recognized the importance of screening for and intervening in the social determinants of health. Designing community-based programming and partnering with social services providers has helped healthcare organizations address the social factors that also impact a patient’s ability to achieve health and wellness.
But screening for SDOH is not always cut-and-dry. Asking a patient about the social factors that are challenging for her or her family can make the patient feel vulnerable, and some evidence has suggested patients feel closed off during those discussions.
“For example, across previous studies, 25% to 94% of patients with positive screening results for food insecurity chose not to receive food assistance,” the researchers reported.
READ MORE: Adapting Social Determinants of Health Screening for Remote Care
A handful of studies have begun to indicate that a strong sense of patient trust and outlining why a provider may screen for SDOH is effective for making a patient feel more comfortable during these conversations.
This latest study adds to that evidence, looking for different demographic characteristics that might predict how open a patient is to a social services referral.
Researchers in seven primary care clinics and four emergency departments in nine states surveyed 1,021 adult patients or adult caregivers of pediatric patients to collect sentiment.
The team used two different surveys, the first of which screened patients for SDOH first, and then asked patients about their interest in receiving a social services referral second. Survey two asked the inverse, first whether patients were interested in social services and second about relevant SDOH.
Just over half (53.3 percent) of respondents screening positive for at least one SDOH said they would like assistance addressing it.
READ MORE: How Accurate Are Social Determinants of Health Screenings?
Patients were more likely to say they are open to social services referral if they completed the second survey, the one that outlined referral options first and asked about SDOH second.
This could be because patients are more likely to disclose what they may perceive as private information if they know there is a solution to their problems. Patients may be less willing to do so if they are unsure whether a clinician can give them help. The second survey implicitly gave patients the former assurance.
“It is possible that reviewing the risks first may have implications for individuals’ perspectives about whether they qualify for assistance, while asking about assistance first could help to convey that the reason for asking about risks is to provide assistance,” the researchers explained.
Patients were also more likely to express interest in social services referral if they screened positive for a higher number of SDOH, had lower household income levels, or self-identified as non-Hispanic Black.
About 8 percent of those screening negative for any SDOH also said they’d like assistance, the researchers found.
READ MORE: Understanding Provider Screening for Social Determinants of Health
Most of these patients were either low-income, had completed an SDOH screening in the past, perceived themselves as qualifying for social services assistance, or having poorer health status. For this group, race or ethnicity was not associated with interest in social services assistance.
“The interest in receiving assistance among those with negative screening results might indicate that assistance initiatives should not be limited to those with positive screening results,” the researchers noted. “Among those with negative screening results, higher interest in receiving assistance was associated with previous exposure to and higher acceptability of social risk screening, which suggests that as social care activities become more common in health care settings, interest in receiving assistance may increase.”
Surprisingly, the researchers did not observe a strong link between screening for SDOH or interest in social services referral and patient trust. This could be because patient trust was high at baseline; patients already trusted that their providers would do what is best for them, which in many cases makes patients more willing to share their social needs.
But perhaps unsurprisingly, the researchers observed equal interest in receiving social services assistance with four of the five SDOH tested in the study: housing, food access, utilities, and transportation.
Patients were less willing to express interest in social services help for exposure to interpersonal violence, likely out of fear of retribution from whoever in their lives in committing that interpersonal violence. This is a persistent challenge.
These study findings may influence how clinicians conduct SDOH screening. For example, clinicians may use this data to first outline the social services referrals they are able to make and then conduct an SDOH screening. Further research may help clarify how to best screen for SDOH.
“As the health care system’s role in addressing social risk factors evolves, more work is needed to understand patients’ perspectives on social risk screening, and patients’ interest in receiving assistance can be used to augment efforts to implement patient-centered social care interventions,” the team concluded.
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October 21, 2020
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Outlining Social Services Options Key to SDOH Screening - PatientEngagementHIT.com
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