Ethnographic investigation of factors affecting conceptualization and provision of social prescribing in outpatient primary care clinics in the United States

项目摘要/摘要 拟议的研究金计划是一个跨学科研究项目，整合了人类学方面的培训， 医学和实施科学。本项目由Adrienne Strong博士、Clarence Gravlee博士监督 (部门)人类学)，拉姆齐·萨卢姆(系)健康结果和生物信息学)和格兰特·哈雷尔 (部门)社区健康和家庭医学)与佛罗里达大学的资源和支持 (UF)文理学院、UF医学院和UF临床翻译 科学研究所。这项提议旨在让学员具备成为一名 在社会科学和临床医学之间架起桥梁的内科科学家。社交 众所周知，健康决定因素(SDH)会影响一系列身心健康的结果。 然而，关于医生如何识别和解释患者的社交信息，以及如何采取行动，人们知之甚少 这些信息支持他们的患者的健康和福祉。这项建议将重点放在美国的门诊患者 初级保健诊所有两个原因：初级保健将患者的整体福祉放在首位 课程，并在最近几年大力推动将SDH干预纳入初级 护理诊所。以前的调查主要集中在筛查工具的开发上，而且有限 干预措施侧重于特殊人群或特定的SDH。这类调查很少关注 提供者和初级保健诊所已经开发出非正式方法来识别和解决临床相关问题 社会条件在日常实践中，活动在这里统称为“社会处方”。因此，一个 调查以跨学科卫生服务和实施科学文献为基础， 探索性部分，以便描述和分析这些尚未调查的做法和 与社交处方有关的信念是有根据的。最重要的假设是患者、提供者和 临床层面因素影响初级保健提供者社会处方的概念化和实施 练习。具体的目标将有助于更好地理解社会科学的知识翻译 初级保健临床医学研究：(1)确定影响社会处方的因素 不同初级保健提供者之间的概念化和(2)确定影响社会的因素 规定在不同的初级保健提供者中实施。成功完成这些研究将 提高对社会处方发展、实施和结果的影响因素的认识 跨不同护理环境的干预措施。这项研究直接针对多种临床和健康服务 国家少数民族健康和健康差距研究所界定的研究兴趣领域。

Project Summary/Abstract The proposed fellowship plan is an interdisciplinary research project integrating training in anthropology, medicine, and implementation science. This project is supervised by Drs. Adrienne Strong, Clarence Gravlee (Dept. of Anthropology), Ramzi Salloum (Dept. of Health Outcomes and Bioinformatics), and Grant Harrell (Dept. of Community Health and Family Medicine) with the resources and support of the University of Florida (UF) College of Liberal Arts and Sciences, the UF College of Medicine and the UF Clinical Translational Sciences Institute. The proposal is designed to equip the trainee with the skills necessary to become a physician-scientist who bridges the divide between the social sciences and clinical medicine. Social Determinants of Health (SDH) are known to impact a wide array of physical and mental health outcomes. However, little is known about how physicians identify and interpret patient social information, and act upon this information in support of their patient’s health and wellbeing. This proposal will focus on US outpatient primary care clinics for two reasons: primary care prioritizes holistic well-being of patients through the life course and there has been a significant push in recent years to incorporate SDH interventions into primary care clinics. Previous investigations have focused primarily on development of screening tools and limited interventions focused on special populations or specific SDH. Such investigations pay little attention to the informal methods providers and primary care clinics have developed to identify and address clinically relevant social conditions in day-to-day practice, activities here collectively termed “social prescribing”. Thus, an investigation grounded in interdisciplinary health services and implementation science literature, with an exploratory component to allow for the description and analysis of these as yet uninvestigated practices and beliefs relating to social prescribing is warranted. The overarching hypothesis is that patient, provider, and clinic level factors affect primary care provider conceptualization and implementation of social prescribing practices. The specific aims will lead to greater understanding of knowledge translation of social science research to clinical medicine in primary care through (1) identification of factors affecting social prescribing conceptualization among diverse primary care providers and (2) identification of factors affecting social prescribing implementation among diverse primary care providers. Successful completion of these studies will enhance understanding of factors affecting development, implementation, and outcomes of social prescribing interventions across diverse care contexts. This research directly targets multiple Clinical and Health Service Research Interest Areas defined by the National Institute of Minority Health and Health Disparities.