Beyond ‘‘Screen & Refer’’: Understanding Families’ Use of Resources for Health-Related Social Needs Identified via Primary Care

IF 3 3区 医学 Q1 PEDIATRICS
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引用次数: 0

Abstract

Objective

As health-related social needs (HRSN) screening increases, attention to families’ resource preferences lags. This study of a pediatric primary care intervention (DULCE) with reliable HRSN screening and resource connection explored whether resources adequately addressed families’ needs and, when HRSN persisted, families' reasons for declining resources.

Methods

This retrospective cohort, mixed-methods study analyzed data from 989 families that received care at seven pediatric clinics implementing DULCE in three states. DULCE screens for seven HRSN around the 1-month and 4-month well-child visits; we calculated the percent of initial and ongoing positive screens. For positive rescreens, we calculated the percent that had all eligible or wanted resources and that were interested in further resources. We also analyzed case notes, which elicited families’ resource preferences, and explored demographic characteristics associated with ongoing HRSN.

Results

Half of enrolled families (508 of 989) initially screened positive for HRSN; 124 families had positive rescreens; 26 expressed interest in further assistance. Most families with ongoing concrete supports needs accessed all eligible resources (60–100%); 20–58% had everything they wanted. Fewer families with ongoing maternal depression and intimate partner violence accessed all eligible resources (48% and 18%, respectively); most reported having all wanted resources (76% and 90%, respectively). Families declined resources due to lack of perceived need, the HRSN resolving, or families addressed HRSN themselves. White families were more likely to rescreen positive.

Conclusions

Pediatric medical homes must honor family-centered decision-making while empowering families to accept beneficial resources. Health care systems should advocate for resources that families need and want.
超越 "筛查和转诊":了解家庭对通过初级保健确定的健康相关社会需求资源的使用情况。
目的:随着健康相关社会需求(HRSN)筛查的增加,对家庭资源偏好的关注却滞后了。本研究通过可靠的健康相关社会需求(HRSN)筛查和资源连接,对儿科初级保健干预措施(DULCE)进行了研究,探讨了资源是否能充分满足家庭的需求,以及当健康相关社会需求持续存在时,家庭拒绝资源的原因:这项回顾性队列混合方法研究分析了在三个州实施 DULCE 的七家儿科诊所接受治疗的 989 个家庭的数据。DULCE 在 1 个月和 4 个月的儿童健康检查中筛查了 7 项 HRSN;我们计算了初次和持续阳性筛查的百分比。对于阳性复筛,我们计算了已获得所有符合条件或想要的资源以及对进一步资源感兴趣的百分比。我们还分析了病例记录,其中询问了家庭的资源偏好,并探讨了与正在进行的 HRSN 相关的人口特征:半数登记家庭(989 个家庭中的 508 个)最初对 HRSN 筛查呈阳性;124 个家庭再次筛查呈阳性;26 个家庭表示有兴趣接受进一步援助。大多数有持续具体支持需求的家庭获得了所有符合条件的资源(60%-100%);20%-58%的家庭获得了他们想要的一切。较少有持续产妇抑郁和亲密伴侣暴力问题的家庭获得了所有符合条件的资源(分别为 48% 和 18%);大多数家庭表示拥有所有想要的资源(分别为 76% 和 90%)。家庭拒绝接受资源的原因有:认为没有需要、HRSN 正在解决或家庭自己解决了 HRSN。白人家庭更有可能重新筛查出阳性结果:儿科医疗之家必须尊重以家庭为中心的决策,同时授权家庭接受有益的资源。医疗保健系统应倡导提供家庭需要和想要的资源。
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来源期刊
Academic Pediatrics
Academic Pediatrics PEDIATRICS-
CiteScore
4.60
自引率
12.90%
发文量
300
审稿时长
60 days
期刊介绍: Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.
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