Part I: A Quantitative Study of Social Risk Screening Acceptability in Patients and Caregivers
Part I: A Quantitative Study of Social Risk Screening Acceptability in Patients and Caregivers
复制标题
DOI：
10.1016/j.amepre.2019.07.010
复制
发表时间：
2019-12-01
影响因子：
5.5
通讯作者：
Gottlieb, Laura M.
中科院分区：
文献类型：
--
作者：
De Marchis, Emilia H.;Hessler, Danielle;Gottlieb, Laura M.
引言：尽管近期基于医疗服务的社会风险筛查有所增长，但对于患者对这些活动的看法知之甚少。本研究评估了患者和照顾者对社会风险筛查的接受度。
方法：这是一项对来自9个州的6家初级保健诊所和4家急诊科招募的969名成年患者以及儿科患者的成年照顾者进行的横断面调查。调查项目包括医疗保险和医疗补助创新中心的负责健康社区社会风险筛查工具，以及关于筛查的适当性以及对将社会风险数据纳入电子健康记录的接受度的问题。逻辑回归评估了与接受度衡量指标相关的协变量关联。数据收集于2018年7月至2019年2月进行；数据分析于2019年2月 - 3月进行。
结果：79%的参与者认为筛查是适当的；65%的人表示对将社会风险纳入电子健康记录感到接受。在调整后的模型中，更高的筛查适当性感知与先前接触过基于医疗服务的社会风险筛查（调整优势比[AOR]=1.82，95%置信区间[CI]=1.16，2.88）、对临床医生的信任（AOR = 1.55，95% CI = 1.00，2.40）以及从初级保健机构招募（AOR = 1.70，95% CI = 1.23，2.38）有关。较低的适当性与先前有过医疗歧视经历有关（AOR = 0.66，95% CI = 0.45，0.95）。对电子健康记录文档更高的接受度与先前在医疗环境中接受过社会风险援助有关（AOR = 1.47，95% CI = 1.04，2.07）。
结论：绝大多数成年患者和儿科患者的照顾者报告称社会风险筛查是适当的。大多数人也对将社会风险数据纳入电子健康记录感到接受。尽管有多种因素影响接受度，但影响程度为中到小。这些发现表明，患者接受度不足不太可能是一个主要的实施障碍。（C）2019年《美国预防医学杂志》。由爱思唯尔公司出版。
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. (C) 2019 American Journal of Preventive Medicine. Published by Elsevier Inc.