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Rodoreda-Pallàs B, Lumillo-Gutiérrez I, Miró Catalina Q, Torra Escarrer E, Sanahuja Juncadella J, Morin Fraile V. Recording of Social Determinants in Computerized Medical Records in Primary Care Consultations: Quasi-Experimental Study. JMIR Form Res 2023; 7:e41706. [PMID: 36696168 PMCID: PMC10013680 DOI: 10.2196/41706] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/30/2022] [Accepted: 12/15/2022] [Indexed: 01/26/2023] Open
Abstract
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 REGISTRATION ClinicalTrials.gov NCT04151056; https://clinicaltrials.gov/ct2/show/NCT04151056.
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Affiliation(s)
- Berta Rodoreda-Pallàs
- Santpedor Primary Health Care, EAP Navarcles/Sant Frutiós /Santpedor, Primary Care Service Bages-Berguedà, Central Catalonia Territorial Management, Institut Català de la Salut, Santpedor, Spain.,Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Research Support Unit of Central Catalonia, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Iris Lumillo-Gutiérrez
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Universitat de Barcelona, Barcelona, Spain.,Chronicity and Complexity Care Unit, Baix Llobregat Centre Primary Care Service, Southern Metropolitan Territorial Management, Institut Català de la Salut, Cornellà de Llobregat (Barcelona), Spain.,Research Group on Environments and Materials for Learning, Universitat de Barcelona, Barcelona, Spain
| | - Queralt Miró Catalina
- Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Research Support Unit of Central Catalonia, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Eva Torra Escarrer
- Sant Vicenç de Castellet Primary Health Care, Primary Care Service Bages-Berguedà, Central Catalonia Territorial Management, Institut Català de la Salut, Sant Vicenç de Castellet, Spain
| | - Jaume Sanahuja Juncadella
- Plaça Catalunya Primary Health Care, Primary Care Service Bages-Berguedà, Central Catalonia Territorial Management, Institut Català de la Salut, Manresa, Spain
| | - Victoria Morin Fraile
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Universitat de Barcelona, Barcelona, Spain.,Research Group on Environments and Materials for Learning, Universitat de Barcelona, Barcelona, Spain.,Health Education and Promotion, Universitat de Barcelona, Barcelona, Spain.,School of Nursing, Universitat de Barcelona, Barcelona, Spain
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