Dataset Information

Screening for Park Access during a Primary Care Social Determinants Screen.

ABSTRACT: While there is evidence that access to nature and parks benefits pediatric health, it is unclear how low-income families living in an urban center acknowledge or prioritize access to parks. METHODS:We conducted a study about access to parks by pediatric patients in a health system serving low-income families. Adult caregivers of pediatric patients completed a survey to identify and prioritize unmet social and economic needs, including access to parks. Univariate and multivariate analyses were conducted to explore associations between lack of access to parks and sociodemographic variables. We also explored the extent to which access to parks competed with other needs. RESULTS:The survey was completed by 890 caregivers; 151 (17%) identified "access to green spaces/parks/playgrounds" as an unmet need, compared to 397 (45%) who endorsed "running out of food before you had money or food stamps to buy more". Being at or below the poverty line doubled the odds ( Odds ratio 1.96, 95% CI 1.16-3.31) of lacking access to a park (reference group: above the poverty line), and lacking a high school degree nearly doubled the odds. Thirty-three of the 151 (22%) caregivers who identified access to parks as an unmet need prioritized it as one of three top unmet needs. Families who faced competing needs of housing, food, and employment insecurity were less likely to prioritize park access (p < 0.001). CONCLUSION:Clinical interventions to increase park access would benefit from an understanding of the social and economic adversity faced by patients.

SUBMITTER: Razani N

PROVIDER: S-EPMC7216015 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Screening for Park Access during a Primary Care Social Determinants Screen.

Razani Nooshin N Long Dayna D Hessler Danielle D Rutherford George W GW Gottlieb Laura M LM

International journal of environmental research and public health 20200417 8

While there is evidence that access to nature and parks benefits pediatric health, it is unclear how low-income families living in an urban center acknowledge or prioritize access to parks.<h4>Methods</h4>We conducted a study about access to parks by pediatric patients in a health system serving low-income families. Adult caregivers of pediatric patients completed a survey to identify and prioritize unmet social and economic needs, including access to parks. Univariate and multivariate analyses ...[more]

PMID: 32316482

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Project description:BackgroundDespite the importance of social determinants in health outcomes, little is known about the best practices for screening and referral during clinical encounters. This study aimed to implement universal social needs screening and community service referrals in an academic emergency department (ED), evaluating for feasibility, reach, and stakeholder perspectives.MethodsBetween January 2019 and February 2020, ED registration staff screened patients for social needs using a 10-item, low-literacy, English-Spanish screener on touchscreens that generated automatic referrals to community service outreach specialists and data linkages. The RE-AIM framework, specifically the constructs of reach and adoption, guided the evaluation. Reach was estimated through a number of approaches, completed screenings, and receipt of community service referrals. Adoption was addressed qualitatively via content analysis and qualitative coding techniques from (1) meetings, clinical interactions, and semi-structured interviews with ED staff and (2) an iterative "engagement studio" with an advisory group composed of ED patients representing diverse communities.ResultsOverall, 4608 participants were approached, and 61% completed the screener. The most common reason for non-completion was patient refusal (43%). Forty-seven percent of patients with completed screeners communicated one or more needs, 34% of whom agreed to follow-up by resource specialists. Of the 482 participants referred, 20% were reached by outreach specialists and referred to community agencies. Only 7% of patients completed the full process from screening to community service referral; older, male, non-White, and Hispanic patients were more likely to complete the referral process. Iterative staff (n = 8) observations and interviews demonstrated that, despite instruction for universal screening, patient presentation (e.g., appearance, insurance status) drove screening decisions. The staff communicated discomfort with, and questioned the usefulness of, screening. Patients (n = 10) communicated a desire for improved understanding of their unmet needs, but had concerns about stigmatization and privacy, and communicated how receptivity of screenings and outreach are influenced by the perceived sincerity of screening staff.ConclusionsDespite the limited time and technical barriers, few patients with social needs ultimately received service referrals. Perspectives of staff and patients suggest that social needs screening during clinical encounters should incorporate structure for facilitating patient-staff relatedness and competence, and address patient vulnerability by ensuring universal, private screenings with clear intent.Trial registrationClinicalTrials.gov, NCT04630041 .

Project description:BackgroundPrimary care telephone access has been associated with patient satisfaction and emergency department utilization even after accounting for objective appointment wait times. However, relatively little is known about how to best structure and manage telephone access in primary care.ObjectiveAssess how primary care telephone access is structured and managed and explore how variation in telephone management may affect primary care teams and patients.DesignWe used 2016 administrative and patient survey data to select six Veterans Administration medical centers (VAMCs) with above-average primary care access (time to third next available appointment) but variable patient-reported access, geographic region, and urbanicity. Semi-structured interviews were conducted August -October 2017.ParticipantsForty-three key stakeholders knowledgeable about primary care, telephone management, and operational priorities nationally and/or within each VAMC.Key resultsTelephone access was organized and managed differently across sites. Regional call centers were perceived as more efficient but less flexible in tailoring processes to meet local needs. Patient preferences for speaking with their own care teams were cited as a reason to manage telephone access locally rather than regionally, particularly in rural sites. Sites with high patient-rated access described call center functions as well-integrated with primary care team workflow, while those with low patient-rated access perceived telephone management practices as negatively affecting primary care team workload. Call center understaffing was a major barrier to optimal telephone access in all six sites, though rural sites reported greater challenges with provider recruitment and retention.ConclusionsIn VA, efforts to improve telephone access have focused on centralizing call center operations but current call center performance metrics do not account for the extent to which call center functions are integrated with primary care workflows or may impact patient experience. Efforts to improve primary care access should carefully consider impact of telephone management practices on providers and patients.

Project description:BackgroundSocial isolation is a known predictor of mortality that disproportionately affects vulnerable populations in the USA. Although experts began to recognize it as a public health crisis prior to 2020, the novel coronavirus pandemic has accelerated recognition of social isolation as a serious threat to health and well-being.ObjectiveExamine patient experiences with screening and assistance for social isolation in primary care settings, and whether patient experiences with these activities are associated with the severity of reported social isolation.DesignCross-sectional survey conducted in 2018.ParticipantsAdults (N = 251) were recruited from 3 primary care clinics in Boston, Chicago, and San Francisco.Main measuresA modified version of the Berkman-Syme Social Network Index (SNI), endorsed by the National Academies of Sciences, Engineering, and Medicine; items to assess for prior experiences with screening and assistance for social isolation.Key resultsIn the sample population, 12.4% reported the highest levels of social isolation (SNI = 0/1), compared to 36.7%, 34.7%, and 16.3% (SNI = 2-4, respectively). Most patients had not been asked about social isolation in a healthcare setting (87.3%), despite reporting no discomfort with social isolation screening (93.9%). Neither discomfort with nor participation in prior screening for social isolation was associated with social isolation levels. Desire for assistance with social isolation (3.2%) was associated with a higher level of social isolation (AOR = 6.0, 95% CI, 1.3-28.8), as well as poor or fair health status (AOR = 9.1; 95% CI, 1.3-64.1).ConclusionsIn this study, few patients reported being screened previously for social isolation in a primary care setting, despite low levels of discomfort with screening. Providers should consider broadening social isolation screening and referral practices in healthcare settings, especially among sicker and more isolated patients who express higher levels of interest in assistance with social isolation.

Project description:Background Social determinants of health may be more important than medical or lifestyle choices in influencing people's health. Even so, there is a deficit in recording these in patients' computerized medical histories. The Spanish administration and the World Health Organization are promoting the recording of diagnoses in computerized clinical histories with the aim of benefiting the individual, the professional, and the community. In most cases, professionals tend to record only clinical diagnoses despite evidence in the literature documenting that addressing the social determinants of health can lead to improvements in health and reductions in social disparities in disease.Objective This study aims to develop and evaluate the effectiveness of a mixed intervention (face-to-face-digital) aimed at improving the quantity and quality of the records of the social determinants of health in computerized medical records at primary care clinics.Methods A quasi-experimental, nonrandomized, controlled, multicenter study with 2 parallel study arms was conducted in the area of Central Catalonia (Spain) with primary care professionals of the Institut Català de la Salut (ICS), working from September 23, 2019, to March 31, 2020. All interested professionals were accepted. In total, 22 basic health areas were involved in the study. In Spain and Catalonia, the International Classification of Diseases is used, in which there is a coding of the social determinants of health. Five social determinants were selected by a physician, a nurse, and a social worker; these professionals had experience in primary care and were experts in community health. The choice was made taking into account the ease of use, benefit, and existing terminology. The intervention, based on the integration of a checklist, was integrated as part of the usual multidisciplinary clinical workflow in primary care consultations to influence the recording of these determinants in the patient's computerized medical record.Results After 6 months of implementing the intervention, the volume and quantity of records of 5 social determinants of health were compared, and a significant increase in the median number of pre- and postintervention diagnoses was observed (P≤.001). There was also an increase in the diversity of selected social determinants. Using the linear regression model, the significant mean increase of the experimental group with respect to the control group was estimated with a coefficient of 8.18 (95% CI 5.11-11.26).Conclusions The intervention described in this study is an effective tool for coding the social determinants of health designed by a multidisciplinary team to be incorporated into the workflow of primary care practices. The effectiveness of its usability and the description of the intervention described here should be generalizable to any environment.Trial registrationClinicalTrials.gov NCT04151056; https://clinicaltrials.gov/ct2/show/NCT04151056.

Dataset Information

Screening for Park Access during a Primary Care Social Determinants Screen.

Publications

Screening for Park Access during a Primary Care Social Determinants Screen.

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