The Feasibility of Screening for Social Determinants of Health: Seven Lessons Learned
If addressing patients' social needs sounds overwhelming, the results of this pilot project might surprise you.
Fam Pract Manag. 2019 Sep-Oct;26(5):13-19.
Author disclosures: no relevant financial affiliations disclosed.
“Social determinants of health” (SDOH) has become an inescapable buzzword in family medicine in part because of the magnitude of impact that SDOH have on our patients' wellbeing. Drawing a direct comparison between social factors and medical conditions, researchers have estimated that low education, racial segregation, and low social support make a contribution to mortality that is equivalent to acute myocardial infarction, cerebrovascular disease, and lung cancer, respectively.1 Particularly as we strive toward the Quadruple Aim in health care, the “conditions in which people are born, grow, live, work, and age”2 can no longer be categorized strictly as nonmedical factors and, therefore, outside the scope of primary care.
Although many in primary care agree about the importance of screening patients for social needs and referring to supportive community resources, legitimate concerns exist about the feasibility of doing so. To explore these issues, our family medicine clinic recently conducted a nine-month SDOH pilot project. This article shares our outcomes and some surprising lessons learned.
Social factors such as low education, racial segregation, and low social support can have an effect on mortality that is similar to medical conditions such as acute myocardial infarction, cerebrovascular disease, and lung cancer.
In the authors' pilot study, 58 percent of clinicians began the project thinking they were too busy for social determinants of health (SDOH) screening, but only 21 percent felt that way by the end of the project.
Numerous SDOH screening tools exist, so practices can simply adapt one for their own use based on the social needs most common in their patient population.
REASONS TO CONSIDER SDOH SCREENING NOW
A variety of forces make this a promising time to integrate SDOH screening into routine medical practice. An early but growing body of evidence provides guidance on how to implement this practice in various settings.3–5 A number of tool-kits exist to support SDOH screening in clinical settings, including those from the American Academy of Family Physicians, American Academy of Pediatrics, and the National Association of Community Health Centers. Previous initiatives have demonstrated that screening for social needs in medical settings is acceptable to patients6 and can result in better access to community resources and resolution of social needs.7,8 Although studies measuring the effect of SDOH screening on health outcomes are limited, some investigators have found benefits related to anxiety,9 blood pressure, and low-density lipoprotein.10
SDOH screening is becoming more financially feasible as alternative payment models such as shared savings programs and global capitation provide a revenue stream to support a
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