Researchers at Virginia Commonwealth University in Richmond discovered that a simple 60-second patient survey gave clinicians insight into obstacles patients faced in staying healthy.
That strategy could prove helpful for busy family physicians who know that social determinants have an enormous impact on their patients' ability to stay healthy but who struggle to squeeze one more task into already crammed office visits.
Details of how the research was conducted and a brief summation of findings are available in an article(www.annfammed.org) titled "A 60-Second Survey to Identify Patients' Unmet Social Needs," that appears in the May/June issue of Annals of Family Medicine.
For this project, corresponding author Sarah Reves, M.S.N., F.N.P.-C., served as a nurse researcher for the VCU Department of Family Medicine and Population Health. In an interview with AAFP News, she said the VCU Health System was looking for the best way to both work with and support local community resources.
- Researchers found that a 60-second survey administered to patients at the Virginia Commonwealth University Health System helped identify obstacles to maintaining good health.
- Patients entering the emergency department and those being admitted as general internal medicine patients checked a few boxes on a card to indicate their unmet needs in the past 30 days.
- More than 60% of patients in both groups reported at least one unmet social need; the three top needs checked were transportation, food and housing.
"With funds in health care stretched so thin, they wanted to determine which resources would have the greatest reach and impact," Reves said.
As a family nurse practitioner, Reves has conversations with patients every day about the importance of taking their medications as prescribed, exercising regularly, eating a well-balanced diet and minimizing stress to improve their health.
However, said Reves, "Social needs drive each one of those factors." If patients lack transportation to pick up their medication, or don't have enough money to buy food or secure safe living conditions, "then it's difficult for them to achieve and continue healthy practices," she said.
Other research collaborators within the VCU Health System were the Office of Health Innovation, general internal medicine inpatient services and the emergency department.
Authors knew they first had to understand the unmet social needs of patients in order to prioritize strategies for providing assistance. "Findings were used to identify partnerships that could connect patients with resources in their communities -- potentially reducing patient health burdens and systemic dysfunction," they wrote.
In the ER setting, a badged medical student approached patients and handed them a 4- by 6-inch card with the short survey. Patients checked a box to indicate gender then saw this question: "In the past 30 days have you needed assistance with any of the following?" Categories listed were
- day care,
- substance abuse,
- domestic violence and
- none of the above.
Patients were invited to check all that applied and were given an option to specify any other concern.
"It truly took only 60 seconds," said Reves. "We were aiming for 500 responses and she (the medical student) approached 547 patients in order to achieve that number."
Reves added that patients were told the project was intended to aid the health system in serving them and improving their health. "From the numbers, you can see they responded very favorably to our request for assistance," she said.
Patients receiving the survey in the general internal medicine intake area were approached by nurses with the same survey that included an additional question asking if patients had been hospitalized in the past 30 days. A total of 75% of patients approached in this area during a four-week period participated in the survey.
In both settings, surveys were written in English and Spanish, and patients were provided with a description of the study as well as a list of local resources they could to tap for assistance with unmet needs.
Researchers reported that ambulatory patients proved "receptive to brief surveys" about their social needs.
Survey findings showed that
- more than 60% of patients reported at least one unmet social need and
- rates of unmet needs were higher among hospitalized patients.
Additionally, unmet social needs indicated most often by patients were
- transportation (26.8% general internal medicine, 18.4% ER),
- food (23.1% and 16.9%) and
- housing (14.2% and 12.7%).
Transportation and food were commonly linked as unmet needs in both groups, as were housing and food.
The triad of transportation, food and housing needs were reported at rates of 17.8% among internal medicine patients and 17.4% for those in the ER.
Additional Author Insight
Reves described how the brief assessment survey could be used in a family medicine clinic.
"If a practice is trying to determine the greatest sources of distress for their patients -- and what resources might be the most favorable to improving their patients' health -- this is an easy way to achieve that.
"Almost any work flow could accommodate the survey. It could be handed out by the front desk, left in exam rooms or presented by the nurses with very little to no impact on staff," she said.
Reves added that primary care practices already have plenty of pressure dealing with patient volume, documentation and reporting demands. "We were really aiming for something simple and self-contained to avoid adding to that stress."
Even the most dedicated practices can't solve every unmet social need for their patients, acknowledged Reves. "But having a basic understanding of those impacting them the most will always benefit patients in the long run," she said.
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