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Frim YG, Garvey KC, Gordon E, Rhodes ET. Screening for Food Insecurity in a Pediatric Diabetes Program: Provider and Parent/Guardian Perspectives. Clin Pediatr (Phila) 2024; 63:1292-1299. [PMID: 38243651 DOI: 10.1177/00099228231222987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Food insecurity (FI) is associated with poor health outcomes in children, and studies have shown higher FI among children with diabetes mellitus. This study assessed provider (N = 22, 35.5% response rate) and parent/guardian (N = 207, 14.6% response rate) perspectives toward FI screening in a pediatric diabetes program. Among 22 providers, most "rarely" (54.5%) or "never" (27.3%) screened for FI although all felt that screening was at least "slightly important." Barriers included lack of time (63.6%), not remembering to screen (59.1%), lack of knowledge about how to address positive screens (45.5%), and being unsure how to screen (40.9%). Among 186 parent/guardians, only 24.1% had been asked about FI at a pediatric medical appointment, but only 8.6% disliked the idea of being asked by a medical provider at endocrinology visits. To be effective and sustainable, FI screening must fit within the visit flow, and providers need education on how to address positive screens.
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Affiliation(s)
- Yonina G Frim
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Pediatrics, Mass General for Children, Boston, MA, USA
| | - Katharine C Garvey
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Erin Gordon
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
- Department of Clinical Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Erinn T Rhodes
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Paul KJ, Virudachalam S, Montoya-Williams D, Lorch S. Associations between food insecurity and low birth weight severity in a national sample. J Perinatol 2024:10.1038/s41372-024-02094-z. [PMID: 39232084 DOI: 10.1038/s41372-024-02094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 06/07/2024] [Accepted: 08/12/2024] [Indexed: 09/06/2024]
Affiliation(s)
- Kathryn Joanna Paul
- Division of Neonatology, The University of North Carolina, Chapel Hill, NC, USA.
| | - Senbagam Virudachalam
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, NC, USA
- PolicyLab, CHOP, Philadelphia, PA, USA
- Clinical Futures, CHOP, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Diana Montoya-Williams
- PolicyLab, CHOP, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Scott Lorch
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
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Loveday S, Chen L, Constable LN, Kabir A, White N, Goldfeld S, Sanci L, Hiscock H. Opening Pandora's box - key facilitators of practice change in detecting and responding to childhood adversity - a practitioner perspective. BMC Pediatr 2024; 24:461. [PMID: 39026201 PMCID: PMC11256471 DOI: 10.1186/s12887-024-04918-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/01/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Childhood adversities worsen physical and mental health across the lifespan. Health and social care practitioners play a key role in identifying and responding to childhood adversity, however, may be reluctant to do so due to a perceived lack of services to refer to, time pressures and a deficit of training and confidence. We aimed to (1) quantify changes in practitioner comfort and confidence to identify and respond to childhood adversity following a multimodal intervention within an integrated child and family health and social care hub and (2) to understand barriers and facilitators of practice change. METHODS Hub practitioners were surveyed about their competence and comfort to directly ask about and confidence to respond to adversity at baseline and then at six and twelve months post training. Interviews were undertaken to explore practitioner barriers and enablers of practice change. Interviews were recorded, transcribed verbatim, and analysed using reflexive thematic analysis. The theoretical domains framework was used to identify the key drivers of practice change. RESULTS Fifteen of 18 practitioners completed all three surveys and 70% reported increased competence and comfort to directly ask, and confidence to respond across a range of adversities over the 12-month intervention. Twenty-one practitioners completed interviews. Six themes were identified as either facilitators or barriers to practice change. Facilitator themes included (1) connection matters, (2) knowledge provides assurance, (3) confidence in ability and (4) choosing change. Barrier themes were (1) never enough time and (2) opening Pandora's box. Following analysis, key drivers of practice change were 'social influence', 'belief in capability', 'knowledge' and 'behaviour regulation' while barriers to practice change were 'environmental context and resources' and 'emotion'. CONCLUSIONS Practitioners reported improved confidence in identifying and responding to adversity through a multimodal intervention delivered in an integrated Child and Family Hub. Changing practice requires more than just education and training. Opportunities for social connection and coaching to improve self-confidence and perceived competence are needed to overcome the fear of opening Pandora's box.
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Affiliation(s)
- Sarah Loveday
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
- Health Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Lingling Chen
- Health Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Leanne N Constable
- Health Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Ashraful Kabir
- Health Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Natalie White
- Policy and Equity, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sharon Goldfeld
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Policy and Equity, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Lena Sanci
- Department of General Practice, University of Melbourne, Parkville, VIC, Australia
| | - Harriet Hiscock
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
- Health Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Centre for Community Child Health, The Royal Children's Hospital, Melbourne, VIC, Australia
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Byhoff E, Rudel R, Taylor LA. Thoughtful Investing in Social Care Management: The Cause of, and Solution to, All of Life's Problems. J Ambul Care Manage 2024; 47:203-211. [PMID: 38771174 DOI: 10.1097/jac.0000000000000502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Elena Byhoff
- Author Affiliations: Division of Health Systems Science, Department of Medicine, Division of Health Information and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, Massachusetts (Dr Byhoff); Division of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts (Dr Rudel); and Division of Healthcare Delivery Science and the Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York.; Division of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts (Dr Rudel); and Division of Healthcare Delivery Science and the Division of Medical Ethics, Department of Population Health, NYU Grossman School of Medicine, New York, New York
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5
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Bleasdale J, Morse GD, Liu Y, Leone LA, Cole K, Przybyla S. Addressing food insecurity in HIV care: perspectives from healthcare and social service providers in New York state. AIDS Care 2024; 36:927-936. [PMID: 38289486 PMCID: PMC11269021 DOI: 10.1080/09540121.2024.2309331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 01/18/2024] [Indexed: 05/05/2024]
Abstract
Ending the HIV epidemic in the United States will require addressing social determinants contributing to poor care engagement among people living with HIV (PLH), such as food insecurity. Food insecurity is associated with poor care engagement among PLH. Yet, few studies have examined the perspectives of healthcare and social services providers on addressing food insecurity in HIV care. Guided by the Social Ecological Model, we conducted semi-structured interviews with 18 providers in New York State to understand barriers and facilitators to addressing food insecurity in HIV care. Thematic analysis illustrated eight themes across various levels of the Social Ecological Model. At the patient-level, providers perceived patients' feelings of embarrassment, shame, and judgement, and low health literacy as barriers. At the provider-level, challenges included limited time. Facilitators included fostering strong, patient-provider relationships. Barriers at the clinic-level included limited funding, while clinic resources served as facilitators. At the community-level, challenges included intersecting stigmas arising from community norms towards PLH and people who receive food assistance and limited access to healthy food. Findings suggest the need to incorporate their insights into the development of interventions that address food insecurity in HIV care.
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Affiliation(s)
- Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Gene D. Morse
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
- Center for Integrated Global Biomedical Sciences, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Yu Liu
- Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Lucia A. Leone
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Kenneth Cole
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
| | - Sarahmona Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
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Alvis CE, Mosha M, Amankwah EK, Hernandez RG, Morrison JM. Comparison of Caregiver and Provider Food Insecurity Screening Preferences Within a Health System. Clin Pediatr (Phila) 2024; 63:650-658. [PMID: 37559340 DOI: 10.1177/00099228231191926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Food insecurity is a public health concern associated with poor health. Evidence guiding how to best implement screening for food insecurity across a pediatric health care system is lacking. We performed a single-center, multi-department, cross-sectional study of caregivers and health care providers in outpatient and inpatient settings to describe the beliefs, barriers, preferences, and preferred food insecurity screening location. Most providers and caregivers underestimated the pervasiveness of food insecurity while acknowledging the benefit of screening. Caregivers are overall receptive to food insecurity screening and disagree with feelings of discomfort or shame when disclosing food insecurity status. Providers acknowledged perceived caregiver discomfort, lack of community food resources, and lack of a validated screening tool as barriers to screening. Both caregivers and providers identified the primary care setting as the preferred screening setting.
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Affiliation(s)
- Courtney E Alvis
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Maua Mosha
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
| | - Ernest K Amankwah
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raquel G Hernandez
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John M Morrison
- Johns Hopkins All Children's Hospital, Saint Petersburg, FL, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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7
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Suarez L, Armstrong S, Fleming R, Howard J, Cholera R. Families Benefit After Utilization of a Clinic-Based Food Pantry Irrespective of Food Insecurity Experiences in a Pediatric Obesity Treatment Program. Am J Health Promot 2024; 38:661-671. [PMID: 38321414 DOI: 10.1177/08901171241229828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
PURPOSE To evaluate the congruence between food insecurity screening outcome and clinic-based food pantry utilization and to examine caregiver reported comfort, motivation, and benefits of utilization. DESIGN Mixed-methods study. SETTING Academic pediatric obesity treatment clinic. SUBJECTS Convenience sample of caregivers. INTERVENTION Clinic-based food pantry offered irrespective of food insecurity screening outcome. MEASURES Food insecurity screening (Hunger Vital Sign) and severity, self-rated caregiver health, willingness to disclose food insecurity and receive food, and food-related stress. ANALYSIS Chi-square and t-tests were utilized to examine associations and descriptive analysis explored benefits. Rapid qualitative analysis was utilized to identify themes. RESULTS Caregivers of 120 children were included (child mean age 11.8; 56.7% female, 67.6% Non-Hispanic Black), with 47 of 59 eligible completing follow-up surveys and 14 completing in-depth interviews. Approximately half (N = 30/59, 50.8%) of families utilizing the food pantry screened negative for food insecurity. Families utilizing the food pantry were more likely to report severe food insecurity (N = 23/59; 38.9%) compared to those declining (N = 3/61; 4.9%, P < .001). Caregivers accepting food were able to meet a child health goal (N = 30/47, 63.8%). Caregivers reported feeling comfortable receiving food (N = 13/14) and felt utilizing the food pantry led to consumption of healthier foods (N = 7/14). CONCLUSIONS Families who screened both positive and negative for food insecurity utilized and benefited from a clinic-based food pantry. Clinics should consider strategies offering food resources to all families irrespective of screening outcome.
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Affiliation(s)
- Lilianna Suarez
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
- Department of Medicine, School of Medicine, Duke University, Durham, NC, USA
| | - Sarah Armstrong
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA
| | - Rachel Fleming
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
| | - Janna Howard
- Duke Center for Childhood Obesity Research, Duke University, Durham, NC, USA
| | - Rushina Cholera
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, USA
- Duke Margolis Center for Health Policy, Duke University, NC, USA
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8
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Baker S, Gallegos D, Rebuli MA, Taylor AJ, Mahoney R. Food Insecurity Screening in High-Income Countries, Tool Validity, and Implementation: A Scoping Review. Nutrients 2024; 16:1684. [PMID: 38892619 PMCID: PMC11174716 DOI: 10.3390/nu16111684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/17/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Household food insecurity has significant negative implications across the lifespan. While routine screening is recommended, particularly in healthcare, guidelines are lacking on selection of screening tools and best-practice implementation across different contexts in non-stigmatizing ways. The objective of this scoping review was to synthesize evidence on household food insecurity screening tools, including psychometrics, implementation in a range of settings, and experiences of carrying out screening or being screened. Four electronic databases were searched for studies in English published from 1990 until June 2023. A total of 58 papers were included, 21 of which focused on tool development and validation, and 37 papers described implementation and perceptions of screening. Most papers were from the USA and described screening in healthcare settings. There was a lack of evidence regarding screening in settings utilized by Indigenous people. The two-item Hunger Vital Sign emerged as the most used and most valid tool across settings. While there is minimal discomfort associated with screening, screening rates in practice are still low. Barriers and facilitators of screening were identified at the setting, system, provider, and recipient level and were mapped onto the COM-B model of behavior change. This review identifies practical strategies to optimize screening and disclosure.
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Affiliation(s)
- Sabine Baker
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, South Brisbane, QLD 4101, Australia; (D.G.); (A.J.T.)
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Danielle Gallegos
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, South Brisbane, QLD 4101, Australia; (D.G.); (A.J.T.)
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | | | - Amanda J. Taylor
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, South Brisbane, QLD 4101, Australia; (D.G.); (A.J.T.)
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia
| | - Ray Mahoney
- Australian e-Health Research Centre, CSIRO Health and Biosecurity, Herston, QLD 4029, Australia;
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Johnson S, Fischer L, Gupta S, Lazerov J, Singletary J, Essel K. "I Felt Like I Had Something I Could Do About It": Pediatric Clinician Experiences With a Food Insecurity-Focused Produce Prescription Program. Clin Pediatr (Phila) 2023; 62:1018-1026. [PMID: 36691293 DOI: 10.1177/00099228221150604] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Efforts to address food insecurity (FI) in pediatric clinics have increased over the last decade, particularly after a groundbreaking 2015 American Academy of Pediatrics policy statement supporting universal routine screening and intervening. Produce prescription programs are a novel strategy addressing FI. Limited data exist on effectiveness and feasibility in pediatric clinical settings. This study explored clinician experiences after enrolling patients who completed a produce prescription program in an urban primary-care clinic in Washington, DC. One year after program completion, the experiences of 11 clinicians were explored through qualitative interviews and coded using thematic content analysis. Identified themes explored changes in clinician knowledge, attitudes, and behaviors. Clinicians expressed that the program offered a tangible resource to address FI, building trust and strengthening their sense of self-efficacy in addressing families' concerns. Incorporation of a produce prescription intervention to address FI was feasible and well accepted by pediatric primary-care clinicians.
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Affiliation(s)
- Sheryl Johnson
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Laura Fischer
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| | - Simran Gupta
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jessica Lazerov
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
| | | | - Kofi Essel
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Children's National Hospital, Washington, DC, USA
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10
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Nguyen CJ, Gold R, Mohammed A, Krancari M, Hoopes M, Morrissey S, Buchwald D, Muller CJ. Food Insecurity Screening in Primary Care: Patterns During the COVID-19 Pandemic by Encounter Modality. Am J Prev Med 2023; 65:467-475. [PMID: 36963473 PMCID: PMC10033146 DOI: 10.1016/j.amepre.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/24/2023]
Abstract
INTRODUCTION Screening for food insecurity in clinical settings is recommended, but implementation varies widely. This study evaluated the prevalence of screening for food insecurity and other social risks in telehealth versus in-person encounters during the COVID-19 pandemic and changes in screening before versus after widespread COVID-19 vaccine availability. METHODS These cross-sectional analyses used electronic health record and ancillary clinic data from a national network of 400+ community health centers with a shared electronic health record. Food insecurity screening was characterized in 2022 in a sample of 275,465 first encounters for routine primary care at any network clinic during March 11, 2020-December 31, 2021. An adjusted multivariate multilevel probit model estimated screening prevalence on the basis of encounter mode (in-person versus telehealth) and time period (initial pandemic versus after vaccine availability) in a random subsample of 11,000 encounters. RESULTS Encounter mode was related to food insecurity screening (p<0.0001), with an estimated 9.2% screening rate during in-person encounters, compared with 5.1% at telehealth encounters. There was an interaction between time period and encounter mode (p<0.0001), with higher screening prevalence at in-person versus telehealth encounters after COVID-19 vaccines were available (11.7% vs 4.9%) than before vaccines were available (7.8% vs 5.2%). CONCLUSIONS Food insecurity screening in first primary care encounters is low overall, with lower rates during telehealth visits and the earlier phase of the COVID-19 pandemic. Future research should explore the methods for enhancing social risk screening in telehealth encounters.
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Affiliation(s)
- Cassandra J Nguyen
- Department of Nutrition, University of California, Davis, Davis, California.
| | - Rachel Gold
- OCHIN Inc., Portland, Oregon; Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Alaa Mohammed
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, Washington
| | | | | | | | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, Washington; Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
| | - Clemma J Muller
- Institute for Research and Education to Advance Community Health, Elson S. Floyd College of Medicine, Washington State University, Seattle, Washington; Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington
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LeLaurin JH, De La Cruz J, Theis RP, Thompson LA, Lee JH, Shenkman EA, Salloum RG. Pediatric primary care provider and staff perspectives on the implementation of electronic health record-based social needs interventions: A mixed-methods study. J Clin Transl Sci 2023; 7:e160. [PMID: 37528941 PMCID: PMC10388413 DOI: 10.1017/cts.2023.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction Interventions to address social needs in clinical settings can improve child and family health outcomes. Electronic health record (EHR) tools are available to support these interventions but are infrequently used. This mixed-methods study sought to identify approaches for implementing social needs interventions using an existing EHR module in pediatric primary care. Methods We conducted focus groups and interviews with providers and staff (n = 30) and workflow assessments (n = 48) at four pediatric clinics. Providers and staff completed measures assessing the acceptability, appropriateness, and feasibility of social needs interventions. The Consolidated Framework for Implementation Research guided the study. A hybrid deductive-inductive approach was used to analyze qualitative data. Results Median scores (range 1-5) for acceptability (4.9) and appropriateness (5.0) were higher than feasibility (3.9). Perceived barriers to implementation related to duplicative processes, parent disclosure, and staffing limitations. Facilitators included the relative advantage of the EHR module compared to existing documentation practices, importance of addressing social needs, and compatibility with clinic culture and workflow. Self-administered screening was seen as inappropriate for sensitive topics. Strategies identified included providing resource lists, integrating social needs assessments with existing screening questionnaires, and reducing duplicative documentation. Conclusions This study offers insight into the implementation of EHR-based social needs interventions and identifies strategies to promote intervention uptake. Findings highlight the need to design interventions that are feasible to implement in real-world settings. Future work should focus on integrating multiple stakeholder perspectives to inform the development of EHR tools and clinical workflows to support social needs interventions.
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Affiliation(s)
- Jennifer H. LeLaurin
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jacqueline De La Cruz
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ryan P. Theis
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lindsay A. Thompson
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Ji-Hyun Lee
- Division of Quantitative Sciences, University of Florida Health Cancer Center, University of Florida, Gainesville, FL, USA
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ramzi G. Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
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12
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Taylor AJ, Baker S, Gallegos D. Intersection of food insecurity and moral experiences of those involved in paediatric healthcare: A scoping review of child, caregiver and healthcare provider perspectives. J Child Health Care 2022:13674935221133476. [PMID: 36384283 DOI: 10.1177/13674935221133476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Food insecurity is a significant social and health issue for children in high-income countries and contributes to sub-optimal child outcomes. This scoping review examines how food insecurity intersects with the moral experiences of those involved in providing and receiving paediatric health care. Multiple databases were searched using a priori inclusion criteria, papers were screened by multiple reviewers. Searches yielded nine papers. Descriptive data was summarised and qualitative results extracted from included papers were analysed using inductive and deductive thematic analysis. Four main themes emerged: Food insecurity threatens caregiver and healthcare provider identity; is food insecurity the business of health? is screening for food insecurity surveillance or facilitating assistance? and the lived experience of navigating the tension of managing food insecurity and a child's health condition. The moral experiences lens has magnified the countless everyday encounters in which values and beliefs about what is 'right' or 'just' can be realised or thwarted in the context of the intersection between healthcare and food insecurity. Review findings have implications relating to the inclusion of children's voices in healthcare settings, healthcare practice and policy design, and the development and use of FI screening tools.
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Affiliation(s)
- Amanda J Taylor
- Woolworths Centre for Childhood Nutrition Research, Faculty of Health, 1969Queensland University of Technology, South Brisbane, QLD, Australia.,School of Exercise and Nutrition Science, Faculty of Health, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Sabine Baker
- Woolworths Centre for Childhood Nutrition Research, Faculty of Health, 1969Queensland University of Technology, South Brisbane, QLD, Australia.,School of Exercise and Nutrition Science, Faculty of Health, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Danielle Gallegos
- Woolworths Centre for Childhood Nutrition Research, Faculty of Health, 1969Queensland University of Technology, South Brisbane, QLD, Australia.,School of Exercise and Nutrition Science, Faculty of Health, 1969Queensland University of Technology, Kelvin Grove, QLD, Australia
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13
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McKay FH, Zinga J, van der Pligt P. Consensus from an expert panel on how to identify and support food insecurity during pregnancy: A modified Delphi study. BMC Health Serv Res 2022; 22:1231. [PMID: 36199090 PMCID: PMC9533284 DOI: 10.1186/s12913-022-08587-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/29/2022] [Accepted: 09/14/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Food insecurity and hunger during pregnancy have significant implications for the health of the mother and baby. Assisting clinicians when they encounter women who are experiencing hunger or food insecurity during their pregnancy will increase the opportunity for better birth and pregnancy outcomes. At present there are no guidelines for Australian clinicians on how to do this. METHODS This study uses a modified Delphi technique, allowing diverse participation in the process, to create consensus on the ways to address and respond to food insecurity during pregnancy. This modified Delphi collected data via two rounds of consensus. The opinions collected from the first round were thematically categorised and grouped. The topics were integrated into the survey for the second round and circulated to participants. During the second round, priorities were scored by giving five points to the topic considered most important, and one point to the least important. RESULTS Through two rounds of consultation, the panel achieved consensus on how to identify food insecurity during pregnancy, with some clear items of consensus related to interventions that could be implemented to address food insecurity during pregnancy. Experts achieved consensus on items that have importance at the institution and policy level, as well as services that exist in the community. The consensus across the spectrum of opportunities for assistance, from the clinical, to community-provided assistance, and on to government policy and practice demonstrate the complexity of this issue, and the multipronged approach that will be required to address it. CONCLUSION This is the first time such a consultation with experts on hunger and food insecurity during pregnancy has been conducted in Australia. Items that achieved consensus and the importance of the issue suggest several ways forward when working with pregnant women who are hungry and/or food insecure.
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Affiliation(s)
- Fiona H McKay
- School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, 3220, Geelong, VIC, Australia.
| | - Julia Zinga
- School of Health and Social Development, Institute for Health Transformation, Faculty of Health, Deakin University, 3220, Geelong, VIC, Australia
- Department of Nutrition and Dietetics, Royal Women's Hospital, Parkville, VIC, Australia
| | - Paige van der Pligt
- The Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, 3220, Geelong, VIC, Australia
- Department of Nutrition Western Health, Footscray, Australia
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14
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Steeves-Reece AL, Nicolaidis C, Richardson DM, Frangie M, Gomez-Arboleda K, Barnes C, Kang M, Goldberg B, Lindner SR, Davis MM. "It Made Me Feel like Things Are Starting to Change in Society:" A Qualitative Study to Foster Positive Patient Experiences during Phone-Based Social Needs Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12668. [PMID: 36231967 PMCID: PMC9566653 DOI: 10.3390/ijerph191912668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Many healthcare organizations are screening patients for health-related social needs (HRSN) to improve healthcare quality and outcomes. Due to both the COVID-19 pandemic and limited time during clinical visits, much of this screening is now happening by phone. To promote healing and avoid harm, it is vital to understand patient experiences and recommendations regarding these activities. We conducted a pragmatic qualitative study with patients who had participated in a HRSN intervention. We applied maximum variation sampling, completed recruitment and interviews by phone, and carried out an inductive reflexive thematic analysis. From August to November 2021 we interviewed 34 patients, developed 6 themes, and used these themes to create a framework for generating positive patient experiences during phone-based HRSN interventions. First, we found patients were likely to have initial skepticism or reservations about the intervention. Second, we identified 4 positive intervention components regarding patient experience: transparency and respect for patient autonomy; kind demeanor; genuine intention to help; and attentiveness and responsiveness to patients' situations. Finally, we found patients could be left with feelings of appreciation or hope, regardless of whether they connected with HRSN resources. Healthcare organizations can incorporate our framework into trainings for team members carrying out phone-based HRSN interventions.
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Affiliation(s)
- Anna L. Steeves-Reece
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Christina Nicolaidis
- School of Social Work, Portland State University, Portland, OR 97201, USA
- Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Dawn M. Richardson
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
| | - Melissa Frangie
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Katherin Gomez-Arboleda
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Chrystal Barnes
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Minnie Kang
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Bruce Goldberg
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Stephan R. Lindner
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Center for Health Systems Effectiveness, Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Melinda M. Davis
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
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15
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Byhoff E, Gottlieb LM. When There Is Value in Asking: An Argument for Social Risk Screening in Clinical Practice. Ann Intern Med 2022; 175:1181-1182. [PMID: 35696689 PMCID: PMC10416218 DOI: 10.7326/m22-0147] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Elena Byhoff
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts (E.B.)
| | - Laura M Gottlieb
- Department of Family and Community Medicine, University of California San Francisco, San Francisco, California (L.M.G.)
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16
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Vasan A, Darko O, Fortin K, Scribano PV, Kenyon CC. Community Resource Connection for Pediatric Caregivers With Unmet Social Needs: A Qualitative Study. Acad Pediatr 2022; 22:461-469. [PMID: 34571255 PMCID: PMC8942862 DOI: 10.1016/j.acap.2021.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Pediatric health systems are increasingly screening caregivers for unmet social needs. However, it remains unclear how best to connect families with unmet needs to available and appropriate community resources. We aimed to explore caregivers' perceived barriers to and facilitators of community resource connection. METHODS We conducted semistructured interviews with caregivers of pediatric patients admitted to one inpatient unit of an academic quaternary care children's hospital. All caregivers who screened positive for one or more unmet social needs on a tablet-based screener were invited to participate in an interview. Interviews were recorded, transcribed, and coded by 2 independent coders using content analysis, resolving discrepancies by consensus. Interviews continued until thematic saturation was achieved. RESULTS We interviewed 28 of 31 eligible caregivers. Four primary themes emerged. First, caregivers of children with complex chronic conditions felt that competing priorities related to their children's medical care often made it more challenging to establish connection with resources. Second, caregivers cited burdensome application and enrollment processes as a barrier to resource connection. Third, caregivers expressed a preference for geographically tailored, web-based resources, rather than paper resources. Last, caregivers expressed a desire for ongoing longitudinal support in establishing and maintaining connections with community resources after their child's hospital discharge. CONCLUSION Pediatric caregivers with unmet social needs reported competing priorities and burdensome application processes as barriers to resource connection. Electronic resources can help caregivers identify locally available services, but longitudinal supports may also be needed to ensure caregivers can establish and maintain linkages with these services.
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Affiliation(s)
- Aditi Vasan
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia (A Vasan and CC Kenyon), Philadelphia, Pa; Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania (A Vasan and CC Kenyon), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania (A Vasan, O Darko, K Fortin, PV Scribano, and CC Kenyon), Philadelphia, Pa.
| | - Olivia Darko
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kristine Fortin
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Philip V. Scribano
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Chén C. Kenyon
- PolicyLab and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA,Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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17
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Abstract
PURPOSE OF REVIEW This article describes the impacts of food insecurity (FI) on child health, outlines clinical and public policy interventions to mitigate FI in children, and defines new paradigms in population health to ameliorate the harmful effects of FI in children. RECENT FINDINGS Rates of FI among children have dramatically increased with the onset of the COVID-19 pandemic, with particular adverse impact on low-income children. Population health innovations in screening, referral, and social service integration offer new opportunities to address FI. SUMMARY Despite advances in clinical practice and public policy, FI remains a persistent issue for many US children. Clinicians and policymakers have opportunities to leverage clinical and community-based integration to improve service delivery opportunities to ameliorate childhood hunger and racial and socioeconomic inequity in the United States.
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Affiliation(s)
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical School, Worcester
| | - Alon Peltz
- Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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18
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Highfield L, Ferguson GM, Holcomb J. Barriers and facilitators to implementation of the Accountable Health Communities (AHC) Model: Findings from a between-site qualitative assessment of implementation strategies. FRONTIERS IN HEALTH SERVICES 2022; 2:926657. [PMID: 36925813 PMCID: PMC10012815 DOI: 10.3389/frhs.2022.926657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022]
Abstract
Introduction A multitude of HRSN interventions are undergoing testing in the U.S., with the CMS Accountable Health Communities (AHC) Model as the largest. HRSN interventions typically include screening for social needs, referral to community resources, and patient navigation to ensure needs are met. There is currently a paucity of evidence on implementation of HRSN interventions. The Consolidated Framework for Implementation Research (CFIR) is a determinant framework widely used to plan and assess implementation. To the authors knowledge, there are no published studies assessing CFIR constructs for HRSN intervention implementation in the U.S. In the Assessment step of the Strengthening Peer AHC Navigation (SPAN) model, a between-site qualitative assessment methodology was used to examine implementation within and between AHC bridge organizations (BOs) within six ERIC implementation strategies identified by the authors based on AHC Model requirements. Objective Our aim was to identify and present between-site barriers and facilitators to AHC Model implementation strategies. Design A multi-site qualitative analysis methodology was used. CFIR determinants were linked to six Expert Recommendations for Implementing Change (ERIC) strategies: staff training, identify and prepare champions, facilitation, community resource engagement (alignment through advisory boards and working groups), data systems, and quality monitoring and assurance. Interviews were analyzed using thematic content analysis in NVivo 12 (QSR International). Setting Five health-related bridge organizations participating in the AHC Model. Results Fifty-eight interviews were completed with 34 staff and 24 patients or patient proxies. Facilitators were identified across five of the six ERIC strategies. Barriers were identified across all six. While organizations found the AHC Model compatible and facilitators to implementation included previous experience, meeting patient needs and resources, and leadership engagement and support, a number of barriers presented challenges to implementation. Issues with adequate staff training, staff skills to resolve HRSN, including patient communication and boundary spanning, setting staff goals, beneficiary caseloads and measurement of progress, data infrastructure (including EHR), available resources to implement and differences in perceptions between clinical delivery site (CDS), and CSP of how to measure and resolve HRSN. Conclusions and relevance The conduct of a pre-implementation readiness assessment benefited from identifying CFIR determinants linked to various ERIC implementation strategies.
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Affiliation(s)
- Linda Highfield
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States.,Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States.,Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P. and Katherine G. McGovern Medical School, Houston, TX, United States
| | - Gayla M Ferguson
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States
| | - Jennifer Holcomb
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Houston, TX, United States.,Sinai Urban Health Institute, Sinai Chicago, Chicago, IL, United States
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19
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Palakshappa D, Ip EH, Berkowitz SA, Bertoni AG, Foley KL, Miller DP, Vitolins MZ, Rosenthal GE. Pathways by Which Food Insecurity Is Associated With Atherosclerotic Cardiovascular Disease Risk. J Am Heart Assoc 2021; 10:e021901. [PMID: 34743567 PMCID: PMC8751929 DOI: 10.1161/jaha.121.021901] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022]
Abstract
Background Food insecurity (FI) has been associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk; however, the pathways by which FI leads to worse cardiovascular health are unknown. We tested the hypothesis that FI is associated with ASCVD risk through nutritional/anthropometric (eg, worse diet quality and increased weight), psychological/mental health (eg, increased depressive symptoms and risk of substance abuse), and access to care pathways. Methods and Results We conducted a cross-sectional study of adults (aged 40-79 years) using the 2007 to 2016 National Health and Nutrition Examination Survey. Our primary exposure was household FI, and our outcome was 10-year ASCVD risk categorized as low (<5%), borderline (≥5% -<7.5%), intermediate (≥7.5%-<20%), and high risk (≥20%). We used structural equation modeling to evaluate the pathways and multiple mediation analysis to determine direct and indirect effects. Of the 12 429 participants, 2231 (18.0%) reported living in a food-insecure household; 5326 (42.9%) had a low ASCVD risk score, 1402 (11.3%) borderline, 3606 (29.0%) intermediate, and 2095 (16.9%) had a high-risk score. In structural models, we found significant path coefficients between FI and the nutrition/anthropometric (β, 0.130; SE, 0.027; P<0.001), psychological/mental health (β, 0.612; SE, 0.043; P<0.001), and access to care (β, 0.110; SE, 0.036; P=0.002) pathways. We did not find a significant direct effect of FI on ASCVD risk, and the nutrition, psychological, and access to care pathways accounted for 31.6%, 43.9%, and 15.8% of the association, respectively. Conclusions We found that the association between FI and ASCVD risk category was mediated through the nutrition/anthropometric, psychological/mental health, and access to care pathways. Interventions that address all 3 pathways may be needed to mitigate the negative impact of FI on cardiovascular disease.
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Affiliation(s)
- Deepak Palakshappa
- Department of Internal MedicineWake Forest School of MedicineWinston‐SalemNC
- Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNC
- Department of PediatricsWake Forest School of MedicineWinston‐SalemNC
| | - Edward H. Ip
- Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNC
| | - Seth A. Berkowitz
- Division of General Medicine and Clinical EpidemiologyDepartment of MedicineUniversity of North Carolina at Chapel Hill School of MedicineChapel HillNC
- Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel HillChapel HillNC
| | - Alain G. Bertoni
- Department of Internal MedicineWake Forest School of MedicineWinston‐SalemNC
- Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNC
| | - Kristie L. Foley
- Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNC
| | - David P. Miller
- Department of Internal MedicineWake Forest School of MedicineWinston‐SalemNC
- Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNC
| | - Mara Z. Vitolins
- Division of Public Health SciencesWake Forest School of MedicineWinston‐SalemNC
| | - Gary E. Rosenthal
- Department of Internal MedicineWake Forest School of MedicineWinston‐SalemNC
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20
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Poulos NS, Nehme EK, O'Neil MM, Mandell DJ. Implementing food bank and healthcare partnerships: a pilot study of perspectives from charitable food systems in Texas. BMC Public Health 2021; 21:2025. [PMID: 34742273 PMCID: PMC8572069 DOI: 10.1186/s12889-021-12031-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/15/2021] [Indexed: 12/05/2022] Open
Abstract
Background Partnerships between charitable food systems and healthcare systems have been forming across the country to support individuals and families experiencing food insecurity, yet little research has focused on these partnerships, particularly from a food bank perspective. The objective of this exploratory pilot study was to identify implementation challenges and facilitators of charitable food system and healthcare partnerships from the food bank perspective. Method Texas food banks with existing food bank/healthcare partnerships were identify through website review and support from Feeding Texas. Interview questions were tailored to each interview, but all focused on identify program components of the food bank/healthcare partnership and implementation barriers/facilitators of the partnership. In total, six interviews were conducted with food bank/healthcare partnership leaders (n = 4) and charitable food system experts (n = 2) about their experiences of working with food bank/healthcare partnerships. All interviews were completed via Zoom and took between 30 and 60 min to completed. Detailed notes were taking during each interview, and immediately discussed with the complete research time to formulate broad implementation themes. Results Interviews suggest unique implementation challenges exist at all levels of food bank/healthcare partnerships including the partnership, program, and system levels. Partnership-level implementation challenges focused on issues of partnership scale and data collection, sharing, and analysis. Program-level implementation challenges focused on food and produce expectations. Structural-level implementation challenges included issues of food safety, subsidized food regulations, and patient privacy. Implementation facilitators included leadership support, mission compatibility/organizational readiness, food insecurity training, and identify of partnership champions. Conclusions This study adds to the growing interest in food bank/healthcare partnership as it highlights unique implementation challenges and facilitators for cross-sector partnerships between healthcare systems and community-based charitable food systems. Ultimately, we believe that collaborative discussion among leaders of charitable food systems and healthcare systems is needed to overcome outlined implementation challenges to better facilitate sustainable, equitable implementation of food bank/healthcare partnerships.
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Affiliation(s)
- Natalie S Poulos
- Department of Community Health, University of Texas Health Science Center at Tyler, 11937 US Hwy 271, Tyler, TX, United States, 75708.
| | - Eileen K Nehme
- Department of Community Health, University of Texas Health Science Center at Tyler, 11937 US Hwy 271, Tyler, TX, United States, 75708
| | - Molly M O'Neil
- Department of Community Health, University of Texas Health Science Center at Tyler, 11937 US Hwy 271, Tyler, TX, United States, 75708
| | - Dorothy J Mandell
- Department of Community Health, University of Texas Health Science Center at Tyler, 11937 US Hwy 271, Tyler, TX, United States, 75708
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21
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Ruiz Escobar E, Pathak S, Blanchard CM. Screening and Referral Care Delivery Services and Unmet Health-Related Social Needs: A Systematic Review. Prev Chronic Dis 2021; 18:E78. [PMID: 34387188 PMCID: PMC8388203 DOI: 10.5888/pcd18.200569] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction Unmet health-related social needs contribute to high patient morbidity and poor population health. A potential solution to improve population health includes the adoption of care delivery models that alleviate unmet needs through screening, referral, and tracking of patients in health care settings, yet the overall impact of such models has remained unexplored. This review addresses an existing gap in the literature regarding the effectiveness of these models and assesses their overall impact on outcomes related to experience of care, population health, and costs. Methods In March 2020, we searched for peer-reviewed articles published in PubMed over the past 10 years. Studies were included if they 1) used a screening tool for identifying unmet health-related social needs in a health care setting, 2) referred patients with positive screens to appropriate resources for addressing identified unmet health-related social needs, and 3) reported any outcomes related to patient experience of care, population health, or cost. Results Of 1,821 articles identified, 35 met the inclusion criteria. All but 1 study demonstrated a tendency toward high risk of bias. Improved outcomes related to experience of care (eg, change in social needs, patient satisfaction, n = 34), population health (eg, diet quality, blood cholesterol levels, n = 7), and cost (eg, program costs, cost-effectiveness, n = 3) were reported. In some studies (n = 5), improved outcomes were found among participants who received direct referrals or additional assistance with indirect referrals compared with those who received indirect referrals only. Conclusion Effective collaborations between health care organizations and community-based organizations are essential to facilitate necessary patient connection to resources for addressing their unmet needs. Although evidence indicated a positive influence of screening and referral programs on outcomes related to experience of care and population health, no definitive conclusions can be made on overall impact because of the potentially high risk of bias in the included studies.
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Affiliation(s)
- Emily Ruiz Escobar
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Shweta Pathak
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina.,UNC Eshelman School of Pharmacy, Center for Medication Optimization, 2400 Kerr Hall, 301 Pharmacy Ln, Chapel Hill, NC 27599-7574.
| | - Carrie M Blanchard
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
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22
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Banks AR, Bell BA, Ngendahimana D, Embaye M, Freedman DA, Chisolm DJ. Identification of factors related to food insecurity and the implications for social determinants of health screenings. BMC Public Health 2021; 21:1410. [PMID: 34271906 PMCID: PMC8284017 DOI: 10.1186/s12889-021-11465-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background Food insecurity and other social determinants of health are increasingly being measured at routine health care visits. Understanding the needs and behaviors of individuals or families who screen positive for food insecurity may inform the types of resources they need. The goal of this research was to identify modifiable characteristics related to endorsement of two food insecurity screener questions to better understand the resources necessary to improve outcomes. Methods Analysis was conducted focusing on cross-sectional survey data collected in 2015–2016 from participants (N = 442) living in urban neighborhoods in Ohio with limited access to grocery stores. Food insecurity was assessed by the endorsement of at least one of two items. These were used to categorize participants into two groups: food insecure(N = 252) or food secure (N = 190). Using logistic regression, we estimated the association between several variables and the food insecure classification. Results Those that used their own car when shopping for food had lower odds of reporting food insecurity, as did those with affirmative attitudes related to the convenience of shopping for and ease of eating healthy foods. As shopping frequency increased, the odds of food insecurity increased. Food insecurity also increased with experience of a significant life event within the past 12 months. There was an 81% increase in the odds of reporting food insecurity among participants who received Supplemental Nutrition Assistance Program benefits compared to those not receiving Supplemental Nutrition Assistance Program benefits. Conclusions Along with referrals to SNAP, clinicians can further address screening-identified food insecurity through provision of transportation supports and linkages to other social services while collaborating on community initiatives to promote convenient and easy access to healthy foods. The needs and behaviors associated with screens indicating food insecurity also have implications for impacting other SDH, and thus, health outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11465-6.
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Affiliation(s)
- Ashley R Banks
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Bethany A Bell
- School of Education and Human Development, University of Virginia, Charlottesville, VA, USA
| | - David Ngendahimana
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Milen Embaye
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Darcy A Freedman
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Deena J Chisolm
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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23
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Cartier Y, Fichtenberg C, Gottlieb LM. Implementing Community Resource Referral Technology: Facilitators And Barriers Described By Early Adopters. Health Aff (Millwood) 2021; 39:662-669. [PMID: 32250665 DOI: 10.1377/hlthaff.2019.01588] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health care organizations are increasingly implementing programs to address patients' social conditions. To support these efforts, new technology platforms have emerged to facilitate referrals to community social services organizations. To understand the functionalities of these platforms and identify the lessons learned by their early adopters in health care, we reviewed nine platforms that were on the market in 2018 and interviewed representatives from thirty-five early-adopter health care organizations. We identified key informants through solicited expert recommendations and web searches. With minor variations, all platforms in the sample provided similar core functionalities: screening for social risks, a resource directory, referral management, care coordination, privacy protection, systems integration, and reporting and analytics. Early adopters reported three key implementation challenges: engaging community partners, managing internal change processes, and ensuring compliance with privacy regulations. We conclude that early engagement with social services partners, funding models that support both direct and indirect costs, and stronger evidence of effectiveness together could help advance platform adoption.
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Affiliation(s)
- Yuri Cartier
- Yuri Cartier ( yuri. cartier@ucsf. edu ) is a research associate in the Social Interventions Research and Evaluation Network, University of California San Francisco
| | - Caroline Fichtenberg
- Caroline Fichtenberg is managing director of the Social Interventions Research and Evaluation Network and a research scientist in the Department of Family and Community Medicine, University of California San Francisco
| | - Laura M Gottlieb
- Laura M. Gottlieb is director of the Social Interventions Research and Evaluation Network and an associate professor in the Department of Family and Community Medicine, University of California San Francisco
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24
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Malhotra NA, Nevar A, Yearby R, Kleinman LC, Ronis S. Medicaid's EPSDT Benefit: An Opportunity to Improve Pediatric Screening for Social Determinants of Health. Med Care Res Rev 2021; 78:87-102. [PMID: 31524053 PMCID: PMC7071991 DOI: 10.1177/1077558719874211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit is a key component of Medicaid policy intended to define an essential set of services provided to patients younger than age 21. Given increasing attention to social determinants of health in pediatric health care, this qualitative review examines the extent to which EPSDT might be used to implement structured screening to identify environmental and social factors affecting children's health. Themes derived from semistructured interviews conducted in 2017 were triangulated with a review of the recent literature to describe how states currently consider the EPSDT benefit with respect to social determinants of health screening. Our findings suggest that, with sufficient stakeholder advocacy given the evidence supporting social determinants of health screening as "medically necessary," EPSDT benefits could be considered as a funding source to incentivize the incorporation of social determinants of health screening into the basic package of well-child care.
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Affiliation(s)
| | - Ann Nevar
- Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | | | - Lawrence C. Kleinman
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sarah Ronis
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- UH Rainbow Center for Child Health and Policy, UH Rainbow Babies & Children’s Hospital, Cleveland, Ohio
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Caldwell JI, Shah-Patel D, Cohen DA, Palimaru AI, Kuo T. Food insecurity, participating in the Supplemental Nutrition Assistance Program, and the degree to which patients anticipate help from clinics to find food in Los Angeles County. Prev Med 2020; 141:106297. [PMID: 33164847 DOI: 10.1016/j.ypmed.2020.106297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 10/04/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
Healthcare clinics are uniquely positioned to screen for food insecurity and refer patients to food resources. This study examines this approach to address this social condition. A 2018 intercept survey of 1,103 adult patients recruited from across 11 clinic waiting rooms in Los Angeles County was conducted to describe the prevalence of food insecurity and whether Supplemental Nutrition Assistance Program (SNAP) participation and the degree to which patients anticipated their clinics to help them locate food varied by socio-demographic factors. The prevalence of food insecurity was high for this low-income survey sample (63.4%); 72% of Spanish-speaking Latinx reported experiencing it. For those who experienced food insecurity, older age was associated with lower odds of SNAP participation. Spanish-speaking Latinx had higher odds of anticipating help from a clinic to find food relative to English-speaking Latinx (Adjusted Odds Ratio 1.88, 95% Confidence Interval: 1.18, 2.98). An exploratory analysis showed that common reasons for not enrolling in SNAP included older adults not knowing how to apply to the program and Spanish-speaking Latinx worrying about citizenship status as it relates to the eligibility process. Findings revealed disparities in the prevalence of food insecurity and SNAP participation among patients of Los Angeles' low income clinics. Information from this study can help inform low-income clinics' efforts to intervene on food insecurity in their patient population.
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Affiliation(s)
- Julia I Caldwell
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, United States of America.
| | - Dipa Shah-Patel
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, United States of America
| | - Deborah A Cohen
- Kaiser Permanente Research and Evaluation, Pasadena, CA, United States of America
| | - Alina I Palimaru
- The RAND Corporation, Santa Monica, CA, United States of America
| | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, United States of America; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, United States of America; Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America; Population Health Program, UCLA Clinical and Translational Science Institute, Los Angeles, CA, United States of America
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Byhoff E, De Marchis EH, Gottlieb L, Halperin-Goldstein S, Nokes K, LeClair AM. Screening for Immigration-Related Health Concerns in a Federally Qualified Health Center Serving a Diverse Latinx Community: A Mixed Methods Study. J Immigr Minor Health 2020; 22:988-995. [PMID: 32277341 PMCID: PMC7442677 DOI: 10.1007/s10903-020-01005-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Immigration-related concerns can impact health and are an important consideration while caring for a multinational Latinx immigrant community. Patients and caregivers waiting for a non-urgent clinic appointment were randomly screened with one of two social risk screening tools. One tool included a question about "any health or stability concerns related to immigration status." The other tool did not include an immigration health question. Immediately following, respondents were invited to participate in a semi-structured interview regarding their social risk screening experience. 201 screens were completed, and 20 patients agreed to an interview. There were no significant sociodemographic differences between groups. Of those screened for immigration, 11% reported a concern. In both arms, interviewees felt that social risk screening was acceptable in a clinic setting. Questions about immigration are timely, important, and relevant, and can be considered when implementing social assessments in communities where there are high levels of trust in providers.
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Affiliation(s)
- Elena Byhoff
- Department of Medicine, Tufts Medical Center, 800 Washington St, Box #63, Boston, USA.
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, 02111, USA.
| | - Emilia H De Marchis
- Department of Family Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Laura Gottlieb
- Department of Family Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Keith Nokes
- Tufts University School of Medicine, Boston, MA, USA
- Department of Family Medicine, Greater Lawrence Family Health Center, Boston, MA, USA
| | - Amy M LeClair
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, 02111, USA
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Herrera CN, Brochier A, Pellicer M, Garg A, Drainoni ML. Implementing Social Determinants of Health Screening at Community Health Centers: Clinician and Staff Perspectives. J Prim Care Community Health 2020; 10:2150132719887260. [PMID: 31702425 PMCID: PMC6843733 DOI: 10.1177/2150132719887260] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose: Screening for social determinants of health (SDOH) during primary care office visits is recommended by pediatric and internal medicine professional guidelines. Less is known about how SDOH screening and service referral can be successfully integrated into clinical practice. Methods: Key informant interviews with 11 community health center (CHC) clinicians and staff members (medical assistants and case managers) were analyzed to identify themes related to integrating a SDOH screening and referral process (augmented WE CARE model) into their workflow. Results: CHC clinicians and staff believed the augmented WE CARE model benefited their patients and the CHC’s mission. Most clinicians found the model was easy to implement. Some staff members had difficulty prioritizing the nonclinical intervention and were confused about their roles and the role of the patient navigator. The eligibility requirements and time needed to access local SDOH resources frustrated clinicians. Discussion: SDOH screening and referral care models can help support the mission of CHCs by identifying unmet material needs. However, CHCs have organizational and administrative challenges that successful interventions must address. CHCs need clinical champions for SDOH models because the screening and follow-up processes involve clinical staff. Additional support for SDOH models might include piloting the SDOH screening model workflow and formalizing the workflow before implementation, including the specific roles for clinicians, staff, and patient navigators.
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Clinician Experiences and Attitudes Regarding Screening for Social Determinants of Health in a Large Integrated Health System. Med Care 2020; 57 Suppl 6 Suppl 2:S197-S201. [PMID: 31095061 DOI: 10.1097/mlr.0000000000001051] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical screening for basic social needs-such as food and housing insecurity-is becoming more common as health systems develop programs to address social determinants of health. Clinician attitudes toward such programs are largely unexplored. OBJECTIVE To describe the attitudes and experiences of social needs screening among a variety of clinicians and other health care professionals. RESEARCH DESIGN Multicenter electronic and paper-based survey. SUBJECTS Two hundred fifty-eight clinicians including primarily physicians, social workers, nurses, and pharmacists from a large integrated health system in Southern California. MEASURES Level of agreement with prompts exploring attitudes toward and barriers to screening and addressing social needs in different clinical settings. RESULTS Overall, most health professionals supported social needs screening in clinical settings (84%). Only a minority (41%) of clinicians expressed confidence in their ability to address social needs, and less than a quarter (23%) routinely screen for social needs currently. Clinicians perceived lack of time to ask (60%) and resources (50%) to address social needs as their most significant barriers. We found differences by health profession in attitudes toward and barriers to screening for social needs, with physicians more likely to cite time constraints as a barrier. CONCLUSIONS Clinicians largely support social needs programs, but they also recognize key barriers to their implementation. Health systems interested in implementing social needs programs should consider the clinician perspective around the time and resources required for such programs and address these perceived barriers.
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Campbell KA, Wuthrich A, Norlin C. We Have All Been Working in Our Own Little Silos Forever: Exploring a Cross-Sector Response to Child Maltreatment. Acad Pediatr 2020; 20:46-54. [PMID: 31185309 PMCID: PMC6899215 DOI: 10.1016/j.acap.2019.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 04/11/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE A child protective services (CPS) investigation for maltreatment signals risk for childhood toxic stress and poor health outcomes. Despite this, communication between child welfare and health care professionals is rare. We present a qualitative exploration of experiences with, barriers to, and hopes for cross-sector collaboration for children with suspected maltreatment. METHODS We conducted focus groups with child welfare and health care professionals participating in a cross-sector learning collaborative to improve care for children at high risk for toxic stress. Participants were asked to describe 2 phenomena: identifying and responding to childhood adversities in their professional settings and cross-sector collaboration in cases of suspected maltreatment. Analysis included an iterative process of reading, coding and comparing themes across groups. RESULTS Health care professionals shared positive experiences in screening for social risks in clinic, while child welfare professionals expressed mixed attitudes toward social risk screening during CPS investigations. Consistent with prior research, health care professionals reported limited communication with CPS caseworkers about patients but suggested that relationships with child welfare professionals might reduce these barriers. Child welfare professionals described the poor quality of information provided in referrals from medical settings. Caseworkers also recognized that improved communication could support better understanding of maltreatment concerns and sharing of outcomes of CPS investigation. CONCLUSIONS Our project extends previously published research by describing potential benefits of child welfare and child health care collaboration in cases of suspected maltreatment. Lack of effective cross-sector communication and concerns about confidentiality present significant barriers to uptake of these collaborative practices.
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Affiliation(s)
- Kristine A Campbell
- Department of Pediatrics (KA Campbell and C Norlin) and Department of Internal Medicine (A Wuthrich), University of Utah, Salt Lake City, Utah.
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Massachusetts Community-Based Organization Perspectives on Medicaid Redesign. Am J Prev Med 2019; 57:S74-S81. [PMID: 31753282 PMCID: PMC7734694 DOI: 10.1016/j.amepre.2019.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The purpose of the study is to investigate how community-based organizations perceive Medicaid policy changes to address the social determinants of health. METHODS This study included 46 key informant interviews, representing 44 community-based organizations across Massachusetts conducted from September 2017 to March 2018. The interviews were designed to collect community-based organizations' perceptions of Medicaid policy changes. An Advisory Board was empaneled for feedback on data collection and analysis. Massachusetts was chosen as a study site in light of explicit policy efforts to incentivize healthcare organizations to take a more active role in social determinants of health, most notably through the creation of Medicaid Accountable Care Organizations. RESULTS The community-based organizations expressed optimism about future partnerships with healthcare organizations. This optimism existed alongside the recognition that healthcare organizations and community-based organizations can have conflicting agendas, including misaligned outcomes of interest and timelines. Community-based organizations struggled to define a clear strategy for partnership in the face of incomplete information about how the final Medicaid redesign would proceed and what healthcare providers would be looking for in a partner. CONCLUSIONS Changes to Medicaid policy can catalyze interest in partnership between healthcare organizations and community-based organizations. To minimize the impact of conflicting agendas, policymakers and healthcare leadership should ensure community-based organizations are part of strategy development and social service program implementation. SUPPLEMENT INFORMATION This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.
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Orr CJ, Chauvenet C, Ozgun H, Pamanes-Duran C, Flower KB. Caregivers' Experiences With Food Insecurity Screening and Impact of Food Insecurity Resources. Clin Pediatr (Phila) 2019; 58:1484-1492. [PMID: 31122058 DOI: 10.1177/0009922819850483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We explored caregivers' experiences with food insecurity screening in a primary care setting and the impact of resources provided. English- and Spanish-speaking food insecure caregivers of children aged 1 to 5 years were recruited. In-depth individual semistructured interviews were conducted (n = 17) eliciting caregivers' experiences with food insecurity, clinic screening, and resources provided. Interviews were audio-recorded and transcribed verbatim. Interviews were double-coded and thematic analysis was used to identify themes and subthemes. All caregivers described multiple and repeat experiences with food insecurity. Food insecurity screening was acceptable, but families were not always connected with resources. Caregivers described WIC (Women, Infants, and Children) as the most commonly used program to address food insecurity and infrequently utilized other food insecurity resources. Screening for food insecurity in primary care was generally well accepted by this sample of food insecure caregivers. Future studies are needed to determine how to improve connecting resources with families most in need.
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Affiliation(s)
- Colin J Orr
- University of North Carolina at Chapel Hill, Chapel Hill NC, USA
| | | | - Holly Ozgun
- University of North Carolina at Chapel Hill, Chapel Hill NC, USA
| | | | - Kori B Flower
- University of North Carolina at Chapel Hill, Chapel Hill NC, USA
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De Marchis EH, Hessler D, Fichtenberg C, Adler N, Byhoff E, Cohen AJ, Doran KM, Ettinger de Cuba S, Fleegler EW, Lewis CC, Lindau ST, Tung EL, Huebschmann AG, Prather AA, Raven M, Gavin N, Jepson S, Johnson W, Ochoa E, Olson AL, Sandel M, Sheward RS, Gottlieb LM. Part I: A Quantitative Study of Social Risk Screening Acceptability in Patients and Caregivers. Am J Prev Med 2019; 57:S25-S37. [PMID: 31753277 PMCID: PMC7336892 DOI: 10.1016/j.amepre.2019.07.010] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Despite recent growth in healthcare delivery-based social risk screening, little is known about patient perspectives on these activities. This study evaluates patient and caregiver acceptability of social risk screening. METHODS This was a cross-sectional survey of 969 adult patients and adult caregivers of pediatric patients recruited from 6 primary care clinics and 4 emergency departments across 9 states. Survey items included the Center for Medicare and Medicaid Innovation Accountable Health Communities' social risk screening tool and questions about appropriateness of screening and comfort with including social risk data in electronic health records. Logistic regressions evaluated covariate associations with acceptability measures. Data collection occurred from July 2018 to February 2019; data analyses were conducted in February‒March 2019. RESULTS Screening was reported as appropriate by 79% of participants; 65% reported comfort including social risks in electronic health records. In adjusted models, higher perceived screening appropriateness was associated with previous exposure to healthcare-based social risk screening (AOR=1.82, 95% CI=1.16, 2.88), trust in clinicians (AOR=1.55, 95% CI=1.00, 2.40), and recruitment from a primary care setting (AOR=1.70, 95% CI=1.23, 2.38). Lower appropriateness was associated with previous experience of healthcare discrimination (AOR=0.66, 95% CI=0.45, 0.95). Higher comfort with electronic health record documentation was associated with previously receiving assistance with social risks in a healthcare setting (AOR=1.47, 95% CI=1.04, 2.07). CONCLUSIONS A strong majority of adult patients and caregivers of pediatric patients reported that social risk screening was appropriate. Most also felt comfortable including social risk data in electronic health records. Although multiple factors influenced acceptability, the effects were moderate to small. These findings suggest that lack of patient acceptability is unlikely to be a major implementation barrier. SUPPLEMENT INFORMATION This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.
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Affiliation(s)
- Emilia H De Marchis
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, California.
| | - Danielle Hessler
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, California
| | - Caroline Fichtenberg
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, San Francisco, California
| | - Nancy Adler
- Center for Health and Community, University of California, San Francisco, San Francisco, California
| | - Elena Byhoff
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts; Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
| | - Alicia J Cohen
- Providence VA Medical Center, Providence, Rhode Island; Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Kelly M Doran
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York
| | | | - Eric W Fleegler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois; Department of Medicine-Geriatrics, University of Chicago, Chicago, Illinois
| | - Elizabeth L Tung
- Section of General Internal Medicine, University of Chicago, Chicago, Illinois
| | - Amy G Huebschmann
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado; Center for Women's Health Research, University of Colorado School of Medicine, Aurora, Colorado
| | - Aric A Prather
- Department of Psychiatry, University of San Francisco, San Francisco, California
| | - Maria Raven
- Department of Emergency Medicine, University of San Francisco, San Francisco, California
| | - Nicholas Gavin
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Susan Jepson
- Upstream Health Innovations, Hennepin County Medical Center, Minneapolis, Minnesota
| | | | - Eduardo Ochoa
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ardis L Olson
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Megan Sandel
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
| | | | - Laura M Gottlieb
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, California
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Eismann EA, Theuerling J, Maguire S, Hente EA, Shapiro RA. Integration of the Safe Environment for Every Kid (SEEK) Model Across Primary Care Settings. Clin Pediatr (Phila) 2019; 58:166-176. [PMID: 30371116 DOI: 10.1177/0009922818809481] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This project sought to assess the generalizability, barriers, and facilitators of implementing the Safe Environment for Every Kid (SEEK) model for addressing psychosocial risk factors for maltreatment across multiple primary care settings, including a pediatric practice, federally qualified health center, and family medicine practice. The SEEK model includes screening caregivers for psychosocial risk factors at well-child visits age 0 to 5 years, brief intervention incorporating principles of motivational interviewing to engage caregivers, and referral to treatment. All practices successfully implemented SEEK, with screening completion rates from 75% to 93% and brief intervention rates from 61% to 81%. Major parental stress (14%) and food insecurity (11%) were the most common risk factors. Providers found SEEK worthwhile for improving their knowledge, skills, and ability to address psychosocial concerns and provide whole person care. Barriers included limited time and resources, incomplete resource knowledge, and lack of follow-up. Facilitators included on-site support staff to assist with communication and referrals.
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Affiliation(s)
- Emily A Eismann
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jack Theuerling
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Elizabeth A Hente
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert A Shapiro
- 1 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,3 University of Cincinnati, Cincinnati, OH, USA
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Cullen D, Woodford A, Fein J. Food for Thought: A Randomized Trial of Food Insecurity Screening in the Emergency Department. Acad Pediatr 2019; 19:646-651. [PMID: 30639763 PMCID: PMC6625934 DOI: 10.1016/j.acap.2018.11.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/02/2018] [Accepted: 11/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Despite the growing interest in screening for food insecurity in the clinical setting, little evidence exists regarding screening formats that maximize disclosure and caregiver comfort. METHODS In this randomized trial, we asked English-speaking adult caregivers of pediatric patients in the emergency department at an urban, freestanding children's hospital to complete a validated, 2-question screen for food insecurity. Respondents were assigned via block randomization to complete the survey by either verbal interview or electronic tablet. Caregivers reported the perceived importance of the screening questions, comfort level with screening in the emergency department or in their child's primary care site, and their preferred screening modality. RESULTS Of the 1818 participants, 20.6% screened positive for food insecurity. There was a significantly higher rate of reported food insecurity for those screened by tablet (23.6%) compared to those screened verbally (17.7%) (P = .002). Of those who had a preference of screening modality, 83.2% of all participants and 84.5% of patients reporting food insecurity preferred the tablet-based screen over verbal interview. Overall, more participants reported comfort completing the screen in the emergency department compared to their child's doctor's office; however, comfort in both of these setting was rated highly (86.1% vs 80.2%; P < .001). CONCLUSIONS Although both verbal interview and tablet-based screening modalities were effective in identifying food insecurity, tablet-based screening had a higher disclosure rate and was the participants' preferred screening method. There is a high level of comfort with screening regardless of clinical setting; it is possible that an added level of anonymity in the emergency department enhanced participants' comfort levels.
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Affiliation(s)
- Danielle Cullen
- Division of Emergency Medicine (D Cullen and J Fein), The Children's Hospital of Philadelphia.
| | - Ashley Woodford
- Thomas Jefferson University, Department of Neurosurgery, 901 Walnut Street, 3rd Floor, Philadelphia PA, 19107
| | - Joel Fein
- The Children’s Hospital of Philadelphia, 3501 Civic Center Blvd, 9th Floor, Philadelphia, PA 19104,
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De Marchis EH, Torres JM, Fichtenberg C, Gottlieb LM. Identifying Food Insecurity in Health Care Settings: A Systematic Scoping Review of the Evidence. FAMILY & COMMUNITY HEALTH 2019; 42:20-29. [PMID: 30431466 DOI: 10.1097/fch.0000000000000208] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This systematic scoping review explores evidence on food insecurity (FI) screening measures, acceptability, and program implementation in health care settings. Validation studies on brief screening tools suggest that instruments exist that adequately measure the construct of FI. Patients and clinicians found FI screening acceptable in a range of clinical settings, though studies are not high quality and rarely reflect substantial patient diversity. Targeted interventions successfully increased screening rates and reduced screening barriers. More research is needed to understand implementation and effectiveness of FI screening in diverse populations to ensure that evolving practices in this area do not widen health inequities.
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Affiliation(s)
- Emilia H De Marchis
- Departments of Family & Community Medicine (Dr De Marchis and Dr Gottlieb) and Epidemiology & Biostatistics (Dr Torres), University of California, San Francisco; and Center for Health & Community, University of California, San Francisco (Dr Fichtenberg)
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Botelho FC, França I. [Can primary health care strengthen the right to adequate food as a human right in Latin America?¿Cómo la atención primaria de salud puede fortalecer la alimentación adecuada como derecho en América Latina?]. Rev Panam Salud Publica 2018; 42:e159. [PMID: 31093187 PMCID: PMC6386033 DOI: 10.26633/rpsp.2018.159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 08/07/2018] [Indexed: 11/24/2022] Open
Abstract
Forty years ago, the Declaration of Alma-Ata emphasized health as a human right, introduced primary health care (PHC) as a strategy to attain an acceptable level of health for all, and included the issue of food and nutrition as an integral part of PHC. The right to adequate food (RAF) is closely related to the right to health, since it is essential to ensure dignified living conditions that promote health. The historical peculiarities and the political and economic position of Latin America constitute barriers for the full realization of human rights, and especially social rights. In this sense, the present article aims to explore the modes by which PHC services can leverage the RAF in Latin America. In addition, the article describes measures that exemplify how countries can strengthen RAF through PHC. Finally, the text seeks to recover the emancipatory potential of PHC through a vision of human rights enforcement beyond the right to health. The overview shows that PHC has the capacity to fulfill human rights that are interdependent on health in the Latin American context.
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Affiliation(s)
- Fernanda Cangussu Botelho
- Universidade de São Paulo (USP), Faculdade de Saúde Pública, Departamento de Saúde, Ciclos de Vida e Sociedade, São Paulo (SP), Brasil
| | - Ivan França
- Universidade de São Paulo (USP), Faculdade de Saúde Pública, Departamento de Saúde, Ciclos de Vida e Sociedade, São Paulo (SP), Brasil
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Beck AF, Cohen AJ, Colvin JD, Fichtenberg CM, Fleegler EW, Garg A, Gottlieb LM, Pantell MS, Sandel MT, Schickedanz A, Kahn RS. Perspectives from the Society for Pediatric Research: interventions targeting social needs in pediatric clinical care. Pediatr Res 2018; 84:10-21. [PMID: 29795202 DOI: 10.1038/s41390-018-0012-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/05/2018] [Accepted: 03/10/2018] [Indexed: 02/06/2023]
Abstract
The social determinants of health (SDoH) are defined by the World Health Organization as the "conditions in which people are born, grow, live, work, and age." Within pediatrics, studies have highlighted links between these underlying social, economic, and environmental conditions, and a range of health outcomes related to both acute and chronic disease. Additionally, within the adult literature, multiple studies have shown significant links between social problems experienced during childhood and "adult diseases" such as diabetes mellitus and hypertension. A variety of potential mechanisms for such links have been explored including differential access to care, exposure to carcinogens and pathogens, health-affecting behaviors, and physiologic responses to allostatic load (i.e., toxic stress). This robust literature supports the importance of the SDoH and the development and evaluation of social needs interventions. These interventions are also driven by evolving economic realities, most importantly, the shift from fee-for-service to value-based payment models. This article reviews existing evidence regarding pediatric-focused clinical interventions that address the SDoH, those that target basic needs such as food insecurity, housing insecurity, and diminished access to care. The paper summarizes common challenges encountered in the evaluation of such interventions. Finally, the paper concludes by introducing key opportunities for future inquiry.
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Affiliation(s)
- Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine; Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.
| | - Alicia J Cohen
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Family Medicine, University of Michigan Medical School, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA
| | - Jeffrey D Colvin
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - Caroline M Fichtenberg
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA
| | - Eric W Fleegler
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Arvin Garg
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Matthew S Pantell
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Megan T Sandel
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Adam Schickedanz
- Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA.,Department of Pediatrics, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Robert S Kahn
- Department of Pediatrics, University of Cincinnati College of Medicine; Division of General & Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco, CA, USA
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38
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Alderwick HAJ, Gottlieb LM, Fichtenberg CM, Adler NE. Social Prescribing in the U.S. and England: Emerging Interventions to Address Patients' Social Needs. Am J Prev Med 2018; 54:715-718. [PMID: 29551326 DOI: 10.1016/j.amepre.2018.01.039] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/24/2018] [Accepted: 01/30/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Hugh A J Alderwick
- Center for Health and Community, University of California, San Francisco, San Francisco, California.
| | - Laura M Gottlieb
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Caroline M Fichtenberg
- Center for Health and Community, University of California, San Francisco, San Francisco, California
| | - Nancy E Adler
- Center for Health and Community, University of California, San Francisco, San Francisco, California
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39
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Stenmark SH, Steiner JF, Marpadga S, Debor M, Underhill K, Seligman H. Lessons Learned from Implementation of the Food Insecurity Screening and Referral Program at Kaiser Permanente Colorado. Perm J 2018; 22:18-093. [PMID: 30296400 PMCID: PMC6175601 DOI: 10.7812/tpp/18-093] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Traditionally, health care systems have addressed gaps in patients' diet quality with programs that provide dietary counseling and education, without addressing food security. However, health care systems increasingly recognize the need to address food security to effectively support population health and the prevention and management of diet-sensitive chronic illnesses. Numerous health care systems have implemented screening programs to identify food insecurity in their patients and to refer them to community food resources to support food security. This article describes barriers encountered and lessons learned from implementation and expansion of the Kaiser Permanente Colorado's clinical food insecurity screening and referral program, which operates in collaboration with a statewide organization (Hunger Free Colorado) to manage clinic-to-community referrals. The immediate goals of clinical screening interventions described in this article are to identify households experiencing food insecurity, to connect them to sustainable (federal) and emergency (community-based) food resources, to alleviate food insecurity, and to improve dietary quality. Additional goals are to improve health outcomes, to decrease health care utilization, to improve patient satisfaction, and to better engage patients in their care.
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Affiliation(s)
- Sandra Hoyt Stenmark
- Pediatrician and Physician Lead of Health Equity in Community Benefit for Kaiser Permanente Colorado in Denver
| | - John F Steiner
- Senior Investigator in the Institute for Health Research at Kaiser Permanente in Denver, CO
| | - Sanjana Marpadga
- Research Analyst at the University of California, San Francisco's Center for Vulnerable Populations
| | - Marydale Debor
- Lecturer in Nutrition at Yale University School of Medicine in New Haven, CT
| | | | - Hilary Seligman
- Associate Professor in the Departments of Medicine and of Epidemiology and Biostatistics at the University of California, San Francisco
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