Assessment of Social Risk Factors and Interest in Receiving Health Care-Based Social Assistance Among Adult Patients and Adult Caregivers of Pediatric Patients.
Assessment of Social Risk Factors and Interest in Receiving Health Care-Based Social Assistance Among Adult Patients and Adult Caregivers of Pediatric Patients.
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DOI：
10.1001/jamanetworkopen.2020.21201
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发表时间：
2020-10-01
影响因子：
13.8
通讯作者：
Gottlieb LM
中科院分区：
文献类型：
--
作者：
De Marchis EH;Hessler D;Fichtenberg C;Fleegler EW;Huebschmann AG;Clark CR;Cohen AJ;Byhoff E;Ommerborn MJ;Adler N;Gottlieb LM
特定社会风险因素是否与患者接受基于医疗保健的社会风险援助的兴趣相关？
在这项针对1021名成年患者以及儿科患者的成年照顾者的横断面研究中，社会风险筛查结果呈阳性的参与者中有53%有兴趣接受社会风险援助，而筛查结果呈阴性的参与者中这一比例为9%。在筛查结果呈阳性的参与者中，在回答社会风险相关问题之前先回答接受援助兴趣问题的参与者、多种风险筛查结果呈阳性的参与者、家庭收入较低的参与者以及自我认定为非西班牙裔黑人血统的参与者，其接受援助的兴趣更高。
该研究结果表明，了解患者对于接受社会风险援助的看法可能是实施以患者为中心的社会关怀干预措施的一个重要考虑因素。
医疗保健机构越来越多地将社会风险筛查纳入患者护理中。研究报告称，患者对于因已确定的社会风险而接受基于医疗保健的援助的兴趣存在很大差异。然而，到目前为止，没有研究考察与患者接受援助的兴趣相关的因素，包括接受援助的兴趣是否因特定的患者人口统计学特征而有所不同。针对这一主题的定向研究可能会提高提供社会关怀服务的基于医疗保健的项目的成功率。
为了确定与接受基于医疗保健的社会风险援助的兴趣相关的参与者特征。
这项横断面研究于2018年7月2日至2019年2月13日在美国9个州的7家初级保健诊所和4家急诊科进行。成年患者以及儿科患者的成年照顾者的便利样本完成了一项筛查调查，该调查测量了社会风险因素以及参与者对于因已确定的社会风险而接受援助的兴趣。参与者被随机选择接受两种版本调查中的一种，这两种版本的区别在于社会风险问题和接受援助兴趣问题的呈现顺序。多变量逻辑回归分析用于评估协变量与参与者接受援助的兴趣之间的关联，并根据社会风险筛查结果进行分层。数据分析时间为2019年9月8日至2020年7月30日。
社会风险筛查问题评估了包括住房、食物、交通、水电费以及遭受人际暴力在内的风险因素。其他问题评估了参与者接受援助的兴趣以及他们对基于医疗保健的社会风险筛查的看法。
参与者对接受基于医疗保健的社会风险援助的兴趣。
共有1021名完成调查回答的成年参与者被纳入分析。其中，1004名参与者中有709名（70.6%）为女性，1007名参与者中有544名（54.0%）年龄在18至44岁之间。总体而言，662名参与者中有353名（53.3%）在1种或多种社会风险因素筛查结果呈阳性的情况下有兴趣接受援助，而所有社会风险筛查结果均为阴性的359名参与者中有31名（8.6%）有兴趣接受援助。1种或多种社会风险因素筛查结果呈阳性的参与者如果在回答社会风险因素问题之前先回答接受援助兴趣问题（调整后的优势比[aOR]，1.48；95%置信区间，1.05 - 2.07）、社会风险因素筛查结果呈阳性的数量较多（aOR，2.40；95%置信区间，1.68 - 3.42）、报告家庭收入水平较低（aOR，7.78；95%置信区间，2.96 - 20.44）或者自我认定为非西班牙裔黑人血统（aOR，2.22；95%置信区间，1.37 - 3.60），则更有可能有兴趣接受援助。在所有社会风险因素筛查结果均为阴性的参与者中，如果参与者报告家庭收入水平较低（aOR，12.38；95%置信区间，2.94 - 52.15）、之前接受过基于医疗保健的社会风险筛查（aOR，2.35；95%置信区间，1.47 - 3.74）、对社会风险筛查的适宜性感知较高（aOR，3.69；95%置信区间，1.08 - 12.55）或者健康状况较差（aOR，4.22；95%置信区间，1.09 - 16.31），其接受援助的兴趣更高。
在这项研究中，多个因素与参与者接受社会风险援助的兴趣相关。这些发现可能对如何以及何时向患者提供社会风险援助有影响。随着医疗保健系统在解决社会风险因素方面的作用不断演变，了解患者对于筛查的看法以及他们接受援助的兴趣对于实施以患者为中心的干预措施可能很重要。
这项横断面研究评估了社会风险因素，并考察了成年患者以及儿科患者的成年照顾者中与接受基于医疗保健的社会风险援助的兴趣相关的特征。
Are specific social risk factors associated with patients’ interest in receiving health care–based social risk assistance? In this cross-sectional study of 1021 adult patients and adult caregivers of pediatric patients, 53% of participants who had positive screening results for social risks were interested in receiving social risk assistance compared with 9% of participants who had negative screening results. Among those with positive screening results, interest in receiving assistance was higher among participants who answered the question about their interest in receiving assistance before answering the questions about social risks and among participants who had positive results for multiple risks, reported lower household income, and self-identified as having non-Hispanic Black ancestry. The study’s findings suggest that understanding patients’ perspectives regarding their interest in receiving social risk assistance may be an important consideration in the implementation of patient-centered social care interventions. Health care organizations are increasingly incorporating social risk screening into patient care. Studies have reported wide variations in patients’ interest in receiving health care–based assistance for identified social risks. However, no study to date has examined the factors associated with patients’ interest in receiving assistance, including whether interest in receiving assistance varies based on specific patient demographic characteristics. Targeted research on this topic could improve the success of health care–based programs that offer social care services. To identify participant characteristics associated with interest in receiving health care–based social risk assistance. This cross-sectional study was conducted in 7 primary care clinics and 4 emergency departments in 9 US states between July 2, 2018, and February 13, 2019. A convenience sample of adult patients and adult caregivers of pediatric patients completed a screening survey that measured social risk factors and participants’ interest in receiving assistance for identified social risks. Participants were randomly selected to receive 1 of 2 versions of the survey, which differed based on the order in which questions about social risks and interest in receiving assistance were presented. Multivariable logistic regression analyses were used to evaluate the associations between covariates and participants’ interest in receiving assistance, stratified by social risk screening results. Data were analyzed from September 8, 2019, to July 30, 2020. Social risk screening questions assessed risk factors comprising housing, food, transportation, utilities, and exposure to interpersonal violence. Additional questions assessed participants’ interest in receiving assistance and their perspectives on health care–based social risk screening. Participant interest in receiving health care–based social risk assistance. A total of 1021 adult participants with complete survey responses were included in the analysis. Of those, 709 of 1004 participants (70.6%) were female, and 544 of 1007 participants (54.0%) were aged 18 to 44 years. Overall, 353 of 662 participants (53.3%) with positive screening results for 1 or more social risk factors were interested in receiving assistance, whereas 31 of 359 participants (8.6%) with negative screening results for all social risks were interested in receiving assistance. Participants with positive screening results for 1 or more social risk factors had a higher likelihood of being interested in receiving assistance if they answered the question about interest in receiving assistance before they answered the questions about social risk factors (adjusted odds ratio [aOR], 1.48; 95% CI, 1.05-2.07), had positive screening results for a higher number of social risk factors (aOR, 2.40; 95% CI, 1.68-3.42), reported lower household income levels (aOR, 7.78; 95% CI, 2.96-20.44), or self-identified as having non-Hispanic Black ancestry (aOR, 2.22; 95% CI, 1.37-3.60). Among those with negative screening results for all social risk factors, the interest in receiving assistance was higher if the participants reported lower household income levels (aOR, 12.38; 95% CI, 2.94-52.15), previous exposure to health care–based social risk screening (aOR, 2.35; 95% CI, 1.47-3.74), higher perceived appropriateness of social risk screening (aOR, 3.69; 95% CI, 1.08-12.55), or worse health status (aOR, 4.22; 95% CI, 1.09-16.31). In this study, multiple factors were associated with participants’ interest in receiving social risk assistance. These findings may have implications for how and when social risk assistance is offered to patients. As the health care system’s role in addressing social risk factors evolves, an understanding of patients’ perspectives regarding screening and their interest in receiving assistance may be important to implementing patient-centered interventions. This cross-sectional study assesses social risk factors and examines characteristics associated with interest in receiving health care–based social risk assistance among adult patients and adult caregivers of pediatric patients.
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