Toward Understanding Social Needs Among Primary Care Patients With Uncontrolled Diabetes.
Toward Understanding Social Needs Among Primary Care Patients With Uncontrolled Diabetes.
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DOI：
10.1177/2150132720985044
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发表时间：
2021-01
影响因子：
3.6
通讯作者：
Hollingsworth N
中科院分区：
文献类型：
--
作者：
Chambers EC;McAuliff KE;Heller CG;Fiori K;Hollingsworth N
不受控制的糖尿病会导致严重的健康并发症，并显着增加与糖尿病相关的发病率、死亡率和医疗费用。很少有研究探讨以黑人和西班牙裔为主的患者群体中未满足的社会需求与糖尿病控制之间的关系。在纽约州布朗克斯的一家大型城市医院系统中，2018 年 4 月至 2019 年 12 月期间在初级保健就诊的 5846 名独特糖尿病患者完成了社会需求筛查。衡量指标包括糖尿病控制（分类为血红蛋白 (Hb) A1c <9.0 为受控，Hb A1C ≥9.0 为未受控）、社会需求（10 项筛查）和人口统计协变量，包括年龄、性别、种族/民族、保险状况、群体贫困百分比、患者的首选语言和 Elixhauser 合并症指数。百分之二十二 (22%) 的患者样本至少有 1 项未满足的社会需求，最普遍的未满足的社会需求是住房问题（包括住房质量和不安全）、粮食不安全和缺乏医疗保健交通。 Logistic回归分析显示，社会需求与未受控制的糖尿病之间存在显着关系，社会需求越多，表明糖尿病不受控制的可能性越大（≥3个需求的调整优势比（AOR）：1.59，95% CI：1.26，2.00）。在调整协变量后，最常出现社交需求未得到满足的患者中，缺乏医疗保健交通（AOR：1.54，95% CI：1.22，1.95）和食品不安全（AOR：1.50，95% CI：1.19，1.89）的患者患糖尿病不受控制的可能性最大。未满足的社会需求似乎与糖尿病不受控制的可能性更大有关。讨论了医疗保健系统筛查和满足糖尿病患者社会需求的影响。
Uncontrolled diabetes can lead to major health complications, and significantly contributes to diabetes-related morbidity, mortality, and healthcare costs. Few studies have examined the relationship between unmet social needs and diabetes control among predominantly Black and Hispanic patient populations. In a large urban hospital system in the Bronx, NY, 5846 unique patients with diabetes seen at a primary care visit between April 2018 and December 2019 completed a social needs screener. Measures included diabetes control (categorized as Hemoglobin (Hb) A1c <9.0 as controlled and Hb A1C ≥9.0 as uncontrolled), social needs (10-item screen), and demographic covariates, including age, sex, race/ethnicity, insurance status, percentage of block-group poverty, patient’s preferred language, and the Elixhauser Comorbidity Index. Twenty-two percent (22%) of the patient sample had at least 1 unmet social need, and the most prevalent unmet social needs were housing issues (including housing quality and insecurity), food insecurity, and lack of healthcare transportation. Logistic regression analysis showed a significant relationship between social needs and uncontrolled diabetes, with more social needs indicating a greater likelihood of uncontrolled diabetes (Adjusted Odds Ratio (AOR) for ≥3 needs: 1.59, 95% CI: 1.26, 2.00). Of the patients with most frequently occurring unmet social needs, lack of healthcare transportation (AOR: 1.54, 95% CI: 1.22, 1.95) and food insecurity (AOR: 1.50, 95% CI: 1.19, 1.89) had the greatest likelihood of having uncontrolled diabetes, after adjusting for covariates. Unmet social needs appear to be linked to a greater likelihood of uncontrolled diabetes. Implications for healthcare systems to screen and address social needs for patients with diabetes are discussed.