Provider type, primary payer, and screener length were all found to influence social determinants of health (SDoH) screening completion rates.
Researchers from the University of South Carolina School of Medicine and Arnold School of Public Health recently conducted a study to determine what factors may interfere with patients completing SDoH screenings with their primary care providers.
Though more and more health systems have recognized the impacts of nonclinical factors, such as food, housing, and transportation, on health outcomes, there are still barriers to conducting necessary SDoH screenings to address those social needs, which this study, published by JAMA Network Open, sought to identify.
“Health systems are increasingly engaging in SDoH screening,” wrote the researchers. “Although such screening can potentially improve health outcomes and reduce health care use, there is limited peer-reviewed evidence incorporating patient and clinician or care team characteristics and perspectives when describing early screening initiatives. Given the personal nature and limited evidence guiding SDoH screening adoption, it is critical to understand stakeholder perspectives.”
Researchers evaluated 78,928 primary care visits completing early intervention SDoH screenings between February and May 2022, looking at factors that may hinder or encourage completion of screenings.
Key findings include:
- Most visits (69.2 percent) were with medical doctors, followed by nurse practitioners (16.5 percent), doctors of osteopathic medicine (7.4 percent), and physician assistants (3.8 percent).
- Most visits (95.4 percent) had no SDoH questions answered. All screening questions were answered in 3.77 percent of visits.
- Screenings were more likely to be completed when done by a physician assistant than by a medical doctor or nurse practitioner.
- Screening rates were lower among patients with Medicaid, patients who were uninsured or had Access Health (a South Carolina program for low-income patients), and patients with Tricare.
- Questions included later in the screener were less likely to be answered.
The research team attributed the varying completion rates by provider to the additional time commitment a screening requires.
Researchers conducted interviews with health care team members and collected feedback from patient experts to gain further perspectives on existing barriers to SDoH screening completion. Key themes revealed in the interviews included:
- Patient hesitancy to answer the questions due to perceptions of intrusiveness
- Limited time and resources for screening and referrals
- Redundant questions that overlap with routine care
- Communication and support facilitators offer the patient
- Inadequate training to operate the screening tool
The results of the study suggest that primary care SDoH screening is feasible, according to the researchers, but the feedback and perspectives of providers and patients must be considered to address the current barriers.
“Although health systems face different challenges in implementing SDoH screening, identifying and addressing common barriers are critical for improved patient activation and care collaboration,” researchers wrote. “Future research should focus on robust assessment of strategies to improve screening uptake.”