Social Risk Factors and Desire for Assistance Among Patients Receiving Subsidized Health Care Insurance in a US-Based Integrated Delivery System
Social Risk Factors and Desire for Assistance Among Patients Receiving Subsidized Health Care Insurance in a US-Based Integrated Delivery System
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DOI：
10.1370/afm.2774
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发表时间：
2022-04-06
影响因子：
4.4
通讯作者：
Lewis, Cara C.
中科院分区：
文献类型：
--
作者：
Tuzzio, Leah;Wellman, Robert D.;Lewis, Cara C.
目的由于食品不安全和住房不稳定等社会条件影响着健康结果，卫生系统正在越来越多地筛查和解决患者的社会风险。这项研究记录了社会风险的普遍性，并检查了在美国的综合交付系统中解决这些风险的愿望。方法对Kaiser Permanente成员进行了一项关于补贴交换医疗保险计划(2018-2019年)的调查。该调查包括社会风险、求助欲望和态度4个领域的问题。结果438名受试者中，212人(48%)报告了至少1个社会危险因素。住房不稳定是最常见的(70%)因素。有社会风险的成员报告说，与没有风险的成员相比，有社会风险的成员报告了更多的不适感筛查(14.2%比5.4%；P=.002)，尽管90%的参与者认为卫生系统应该帮助解决社会风险。然而，在那些有1-2个社会风险的人中，只有29%的人希望得到帮助。报告有社会风险的非西班牙裔黑人参与者希望得到帮助的可能性是非西班牙裔白人参与者的两倍多(调整后的相对风险[RR]2.2；95%CI，1.3-3.8)。结论尽管大多数调查参与者认为卫生系统在应对社会风险方面发挥了作用，但报告有风险的人中有一小部分希望得到帮助，并报告说比没有风险的人更不舒服。卫生系统应该努力提高患者报告风险的舒适度，探索如何在需要时成功地帮助他们，并提供资源在卫生保健部门之外解决这些风险。
PURPOSE Because social conditions such as food insecurity and housing instability shape health outcomes, health systems are increasingly screening for and addressing patients' social risks. This study documented the prevalence of social risks and examined the desire for assistance in addressing those risks in a US-based integrated delivery system.METHODS A survey was administered to Kaiser Permanente members on subsidized exchange health insurance plans (2018-2019). The survey included questions about 4 domains of social risks, desire for help, and attitudes. We conducted a descriptive analysis and estimated multivariate modified Poisson regression models.RESULTS Of 438 participants, 212 (48%) reported at least 1 social risk factor. Housing instability was the most common (70%) factor reported. Members with social risks reported more discomfort being screened for social risks (14.2% vs 5.4%; P=.002) than those without risks, although 90% of participants believed that health systems should assist in addressing social risks. Among those with 1-2 social risks, however, only 29% desired assistance. Non-Hispanic Black participants who reported a social risk were more than twice as likely to desire assistance compared with non-Hispanic White participants (adjusted relative risk [RR] 2.2; 95% CI, 1.3-3.8).CONCLUSIONS Athough most survey participants believed health systems have a role in addressing social risks, a minority of those reporting a risk wanted assistance and reported more discomfort being screened for risk factors than those without risks. Health systems should work to increase the comfort of patients in reporting risks, explore how to successfully assist them when desired, and offer resources to address these risks outside the health care sector.