临床医生对患者报告的与健康相关的社会需求的认识:还有改进的余地。

IF 3 Q1 PRIMARY HEALTH CARE
Andrea Nederveld, Kaitlyn Booske Bertin, Louise Miriam Dickinson, Shivani Beall, Jordan Nelson, Russell E Glasgow, Amy G Huebschmann
{"title":"临床医生对患者报告的与健康相关的社会需求的认识:还有改进的余地。","authors":"Andrea Nederveld, Kaitlyn Booske Bertin, Louise Miriam Dickinson, Shivani Beall, Jordan Nelson, Russell E Glasgow, Amy G Huebschmann","doi":"10.1177/21501319241290887","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>People experiencing health-related social needs (HRSNs), such as transportation insecurity, are less likely to undergo preventive health screenings. They are more likely to have worse health outcomes overall, including a higher rate of late-stage cancer diagnoses. If primary care clinicians are aware of HRSNs, they can tailor preventive care, including cancer screening approaches. Accordingly, recent guidelines recommend that clinicians \"adjust\" care based on HRSNs. This study assessed the level of clinician awareness of patient-reported HRSNs and congruence between clinician perception and patient-reported HRSNs.</p><p><strong>Methods: </strong>We surveyed patients aged 50 to 85 years and their clinicians in 3 primary care clinics that routinely screen patients for HRSNs. Patients and clinicians reported the presence/absence of 6 HRSNs, including food, transportation, housing and financial insecurity for medications/healthcare, financial insecurity for utilities, and social isolation. Kappa statistics assessed the concordance of reported HRSNs between patients and clinicians.</p><p><strong>Results: </strong>Across 237 paired patient-clinician surveys, mean patient age was 65 years, and 62% and 13% of patients were female and Latinx/Hispanic, respectively. Concordance between clinician- and patient-reported HRSNs varied by HRSN, with the lowest agreement for food insecurity (kappa = .08; 95% CI: 0.00, 0.17; <i>P</i> = .01) and highest agreement for transportation insecurity (kappa = .39; 95% CI: 0.18, 0.59; <i>P</i> < .001). The other HRSNs assessed were housing insecurity (kappa = .30; 95% CI: 0.05, 0.55; <i>P</i> < .001), social isolation (kappa = .24; 95% CI: 0.03, 0.45; <i>P</i> < .001), financial insecurity for utilities (kappa = .21; 95% CI: -0.02, 0.45; <i>P</i> < .001), and financial insecurity for healthcare/medications (kappa = .12; 95% CI: -0.02, 0.27; <i>P</i> < .001). In particular, discrepancies were noted in food insecurity prevalence: patient-reported food insecurity was 29% whereas clinician-reported food insecurity was only 3%.</p><p><strong>Discussion: </strong>Clinician awareness of patients' social needs was only modest to fair, and varied by specific HRSN. In order to adjust care for HRSNs, clinics need processes for increased sharing of patient-reported HRSNs screening information with the entire clinical team. Future research should explore options for sharing HRSN data across teams and evaluate whether better HRSN data-sharing impacts outcomes.</p>","PeriodicalId":46723,"journal":{"name":"Journal of Primary Care and Community Health","volume":null,"pages":null},"PeriodicalIF":3.0000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494667/pdf/","citationCount":"0","resultStr":"{\"title\":\"Clinician Awareness of Patient-Reported Health-Related Social Needs: There's Room for Improvement.\",\"authors\":\"Andrea Nederveld, Kaitlyn Booske Bertin, Louise Miriam Dickinson, Shivani Beall, Jordan Nelson, Russell E Glasgow, Amy G Huebschmann\",\"doi\":\"10.1177/21501319241290887\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>People experiencing health-related social needs (HRSNs), such as transportation insecurity, are less likely to undergo preventive health screenings. They are more likely to have worse health outcomes overall, including a higher rate of late-stage cancer diagnoses. If primary care clinicians are aware of HRSNs, they can tailor preventive care, including cancer screening approaches. Accordingly, recent guidelines recommend that clinicians \\\"adjust\\\" care based on HRSNs. This study assessed the level of clinician awareness of patient-reported HRSNs and congruence between clinician perception and patient-reported HRSNs.</p><p><strong>Methods: </strong>We surveyed patients aged 50 to 85 years and their clinicians in 3 primary care clinics that routinely screen patients for HRSNs. Patients and clinicians reported the presence/absence of 6 HRSNs, including food, transportation, housing and financial insecurity for medications/healthcare, financial insecurity for utilities, and social isolation. Kappa statistics assessed the concordance of reported HRSNs between patients and clinicians.</p><p><strong>Results: </strong>Across 237 paired patient-clinician surveys, mean patient age was 65 years, and 62% and 13% of patients were female and Latinx/Hispanic, respectively. Concordance between clinician- and patient-reported HRSNs varied by HRSN, with the lowest agreement for food insecurity (kappa = .08; 95% CI: 0.00, 0.17; <i>P</i> = .01) and highest agreement for transportation insecurity (kappa = .39; 95% CI: 0.18, 0.59; <i>P</i> < .001). The other HRSNs assessed were housing insecurity (kappa = .30; 95% CI: 0.05, 0.55; <i>P</i> < .001), social isolation (kappa = .24; 95% CI: 0.03, 0.45; <i>P</i> < .001), financial insecurity for utilities (kappa = .21; 95% CI: -0.02, 0.45; <i>P</i> < .001), and financial insecurity for healthcare/medications (kappa = .12; 95% CI: -0.02, 0.27; <i>P</i> < .001). In particular, discrepancies were noted in food insecurity prevalence: patient-reported food insecurity was 29% whereas clinician-reported food insecurity was only 3%.</p><p><strong>Discussion: </strong>Clinician awareness of patients' social needs was only modest to fair, and varied by specific HRSN. In order to adjust care for HRSNs, clinics need processes for increased sharing of patient-reported HRSNs screening information with the entire clinical team. Future research should explore options for sharing HRSN data across teams and evaluate whether better HRSN data-sharing impacts outcomes.</p>\",\"PeriodicalId\":46723,\"journal\":{\"name\":\"Journal of Primary Care and Community Health\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11494667/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Primary Care and Community Health\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/21501319241290887\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PRIMARY HEALTH CARE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Primary Care and Community Health","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/21501319241290887","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PRIMARY HEALTH CARE","Score":null,"Total":0}
引用次数: 0

摘要

导言:有健康相关社会需求(HRSNs)的人,如交通不便者,不太可能接受预防性健康检查。他们的总体健康状况更差,包括晚期癌症诊断率更高。如果初级保健临床医生了解 HRSN,他们就可以为患者量身定制预防性保健,包括癌症筛查方法。因此,最近的指南建议临床医生根据 HRSNs "调整 "护理。本研究评估了临床医生对患者报告的 HRSNs 的了解程度,以及临床医生的认知与患者报告的 HRSNs 之间的一致性:我们对 3 家常规筛查 HRSN 患者的初级保健诊所中 50 至 85 岁的患者及其临床医生进行了调查。患者和临床医生报告了 6 项 HRSNs 的存在/不存在情况,包括食物、交通、住房和药物/医疗保健方面的经济不安全、公用事业方面的经济不安全以及社会隔离。卡帕统计评估了患者和临床医生报告的 HRSNs 的一致性:在 237 份患者与临床医生的配对调查中,患者的平均年龄为 65 岁,女性和拉美/西班牙裔患者分别占 62% 和 13%。临床医生和患者报告的 HRSN 之间的一致性因 HRSN 而异,食物不安全的一致性最低(kappa = .08; 95% CI: 0.00, 0.17; P = .01),交通不安全的一致性最高(kappa = .39; 95% CI: 0.18, 0.59; P P P P P 讨论:临床医生对患者社会需求的了解程度仅为一般至中等,且因具体的 HRSN 而异。为了调整对 HRSN 的护理,诊所需要与整个临床团队更多地共享患者报告的 HRSN 筛查信息。未来的研究应探索跨团队共享 HRSN 数据的方案,并评估更好的 HRSN 数据共享是否会影响治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinician Awareness of Patient-Reported Health-Related Social Needs: There's Room for Improvement.

Introduction: People experiencing health-related social needs (HRSNs), such as transportation insecurity, are less likely to undergo preventive health screenings. They are more likely to have worse health outcomes overall, including a higher rate of late-stage cancer diagnoses. If primary care clinicians are aware of HRSNs, they can tailor preventive care, including cancer screening approaches. Accordingly, recent guidelines recommend that clinicians "adjust" care based on HRSNs. This study assessed the level of clinician awareness of patient-reported HRSNs and congruence between clinician perception and patient-reported HRSNs.

Methods: We surveyed patients aged 50 to 85 years and their clinicians in 3 primary care clinics that routinely screen patients for HRSNs. Patients and clinicians reported the presence/absence of 6 HRSNs, including food, transportation, housing and financial insecurity for medications/healthcare, financial insecurity for utilities, and social isolation. Kappa statistics assessed the concordance of reported HRSNs between patients and clinicians.

Results: Across 237 paired patient-clinician surveys, mean patient age was 65 years, and 62% and 13% of patients were female and Latinx/Hispanic, respectively. Concordance between clinician- and patient-reported HRSNs varied by HRSN, with the lowest agreement for food insecurity (kappa = .08; 95% CI: 0.00, 0.17; P = .01) and highest agreement for transportation insecurity (kappa = .39; 95% CI: 0.18, 0.59; P < .001). The other HRSNs assessed were housing insecurity (kappa = .30; 95% CI: 0.05, 0.55; P < .001), social isolation (kappa = .24; 95% CI: 0.03, 0.45; P < .001), financial insecurity for utilities (kappa = .21; 95% CI: -0.02, 0.45; P < .001), and financial insecurity for healthcare/medications (kappa = .12; 95% CI: -0.02, 0.27; P < .001). In particular, discrepancies were noted in food insecurity prevalence: patient-reported food insecurity was 29% whereas clinician-reported food insecurity was only 3%.

Discussion: Clinician awareness of patients' social needs was only modest to fair, and varied by specific HRSN. In order to adjust care for HRSNs, clinics need processes for increased sharing of patient-reported HRSNs screening information with the entire clinical team. Future research should explore options for sharing HRSN data across teams and evaluate whether better HRSN data-sharing impacts outcomes.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
4.80
自引率
2.80%
发文量
183
审稿时长
15 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信