Frequency and nature of discussing social influences on health in urban safety-net clinics: A qualitative analysis.
Frequency and nature of discussing social influences on health in urban safety-net clinics: A qualitative analysis.
复制标题
城市安全网诊所讨论社会对健康影响的频率和性质：定性分析。
DOI：
10.1016/j.pec.2023.107974
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发表时间：
2023
影响因子：
3.5
通讯作者：
Schoenthaler,AntoinetteM
中科院分区：
文献类型：
--
作者：
Chebly,KatherineOtto;Shen,Michael;Schoenthaler,AntoinetteM
慢性社会隔离是全因死亡率和疾病进展的一个危险因素，但在临床环境中没有进行常规筛查。本研究分析了提供者与患者的沟通模式，在初级保健遇到的社会影响，以确定机会，筛选客观或感知的社会isolation.MethodsContent分析进行了97个录音，讲英语的病人遇到27个初级保健提供者在3个安全网初级保健中心在纽约市的成绩单。对话首先针对特定的社会隔离筛查进行编码，然后更广泛地量化和限定如何讨论与健康相关的社会影响。结果成绩单没有包含社会隔离筛查的明确示例。与药物依从性（93%）和饮食（64%）相比，只有28%的成绩单有意义地讨论了社会对健康的影响。患者发起的对话对健康的社会影响的两倍，往往供应商，但供应商没有承认67%的这些prompts.ConclusionSocial对健康的影响，包括社会隔离，是不常见的讨论，在这个样本的初级保健访问。当社会影响进行了有意义的讨论，供应商利用关系为中心的沟通strategies.Practice implicationsStrategic关于社会影响的对话，即使是简短和非正式的，可以有效地筛选患者的社会孤立。
ObjectiveChronic social isolation is a risk factor for all-cause mortality and disease progression, but is not routinely screened for in clinical settings. This study analyzed provider-patient communication patterns about social influences during primary care encounters, to identify opportunities to screen for objective or perceived social isolation.MethodsContent analysis was conducted on transcripts of 97 audiotaped, English-speaking patient encounters with 27 primary care providers at 3 safety-net primary care centers in New York City. Conversations were first coded for specific social isolation screening, then more broadly to quantify and qualify how social influences were discussed in relation to health.ResultsTranscripts included no explicit examples of social isolation screening. Social influences on health were discussed meaningfully in only 28 % of transcripts, compared to medication adherence (93 %) and diet (64 %). Patients initiated conversations about social influences on health twice as often as providers, however providers did not acknowledge 67% of these prompts.ConclusionSocial influences on health, including social isolation, were uncommonly discussed in this sample of primary care visits. When social influences were discussed meaningfully, providers utilized relationship-centered communication strategies.Practice implicationsStrategic conversations about social influences, even when brief and informal, can effectively screen patients for social isolation.