Journal Article

Implementation of social needs screening in primary care: a qualitative study using the health equity implementation framework

Zullig, Leah L., Drake, Connor, Batchelder, Heather, Cannady, Meagan, Esmaili, Emily, Haley, Amber, Lewinski, Allison, Weinberger, Morris, Edelman, David, Shea, Christopher M., Eisenson, Howard, Lian, Tyler

2021

Overview

Background Screening in primary care for unmet individual social needs (e.g., housing instability, food insecurity, unemployment, social isolation) is critical to addressing their deleterious effects on patients’ health outcomes. To our knowledge, this is the first study to apply an implementation science framework to identify implementation factors and best practices for social needs screening and response. Methods Guided by the Health Equity Implementation Framework (HEIF), we collected qualitative data from clinicians and patients to evaluate barriers and facilitators to implementing the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE), a standardized social needs screening and response protocol, in a federally qualified health center. Eligible patients who received the PRAPARE as a standard of care were invited to participate in semi-structured interviews. We also obtained front-line clinician perspectives in a semi-structured focus group. HEIF domains informed a directed content analysis. Results Patients and clinicians (i.e., case managers) reported implementation barriers and facilitators across multiple domains (e.g., clinical encounters, patient and provider factors, inner context, outer context, and societal influence). Implementation barriers included structural and policy level determinants related to resource availability, discrimination, and administrative burden. Facilitators included evidence-based clinical techniques for shared decision making (e.g., motivational interviewing), team-based staffing models, and beliefs related to alignment of the PRAPARE with patient-centered care. We found high levels of patient acceptability and opportunities for adaptation to increase equitable adoption and reach. Conclusion Our results provide practical insight into the implementation of the PRAPARE or similar social needs screening and response protocols in primary care at the individual encounter, organizational, community, and societal levels. Future research should focus on developing discrete implementation strategies to promote social needs screening and response, and associated multisector care coordination to improve health outcomes and equity for vulnerable and marginalized patient populations.

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Child & adolescent mental health / Clinics / Community / Content analysis / Continuity of care / Data collection / Electronic health records / Focus groups / Health Administration / Health disparities / Health equity implementation framework / Health Informatics / Health services / Medicaid / Medicine / Medicine & Public Health / Mental health / Nursing Research / Patient-centered care / Pediatrics / PRAPARE / Primary care / Public Health / Qualitative research / Shared decision making / Social determinants of health / Social exclusion / Social needs