Hilary Placzek, PhD, MPH, senior director of research at Clarify Health Solutions, recently co-authored a paper published in The Journal of General Internal Medicine titled “Patient Perspectives on Addressing Social Needs in Primary Care Using a Screening and Resource Referral Intervention.” The study analyzed qualitative data collected from over 100 interviews with patients treated at a large integrated health system in Contra Costa County, Northern California.
We sat down with Dr. Placzek to better understand the outcomes of the study and their implications on how providers should be designing social interventions in their communities and measuring their impact.
Q: What were the goals of your study?
A: We wanted to understand patients’ perceptions of established social interventions and support services. Integrating the patient voice into the interventions we design and outcomes we measure is a critical component in the social and behavioral determinants of health (SBDoH) space. Only by understanding patients’ perceptions and self-reported outcomes, can we further optimize these interventions and better embed them in complicated clinical care workflows, especially when patient needs are complex and require different layers of care.
It is important to note that social and behavioral interventions are fairly well-established in healthcare practices across the Bay Area in California. Patients are screened for baseline social needs by patient advocates (care navigators, community or social workers), and then matched to community programs and resources that can best meet their needs.
Q: What were the important findings of the study?
A: As we looked for emerging themes among the qualitative responses, we found components of human-centered interventions that worked well. We gained an understanding of patients’ reactions to social interventions, how patients use and access social services in the community, and descriptions of impacts on patients’ abilities to access services. Many patients reported concrete changes in their lives as a result of the support provided by the advocates. This is a level of qualitative insight that is impossible to surface from quantitative administrative and claims data alone.
Our analysis included rich elements of the patient-provider relationship that led to meaningful, trusting communication. These results underscore the importance of the element of trust in providing care to individuals. We saw overwhelmingly positive reactions to social interventions and a deep appreciation for advocates who provided support. These findings provide detailed descriptions of the therapeutic relationship and working alliance between patients and providers which potentially impact outcomes like adherence to treatment and quality of life.
This begs the questions: How do we develop predictors of trusted relationships? How do we develop care pathways that incorporate the interplay of trust and other social factors?
Q: What did you learn about how patients use and access services in their communities? OR was there any surprising data that emerged from respondent information?
A: We worked through a lot of rich data on barriers that patients encounter in accessing social support. Those barriers were found to be significant and we grouped them into two types of barriers:
- Personal-level barriers:
Patients’ mental and physical health states inhibit them from accessing services. Other complicated and complex priorities, like another sick family member or physical disabilities, can get in the way of these patients accessing the available support.
- Systemic-level barriers:
Patients may have limited availability or accessibility to a resource, for example, lack of affordable housing (which is common in northern California), or needing to take four buses to get to the location of the service offered.
Oftentimes there is an interplay between both personal- and systemic-level barriers that patients reported which speaks to the complex ways that patients must navigate social services in their communities, and the need for more work to be done to understand how to improve availability and accessibility of social service infrastructure.
Q: Why is it important to address social determinants of health when designing primary care interventions?
A: It has been well-established that when social factors are addressed it influences illness, recuperation, and wellness. However, we need to better understand how these social factors impact each other as well as how they impact longitudinal health outcomes.
Our research team at Clarify is digging deeper into understanding the pathways associated with social and behavioral determinants of health, and how different factors — like access to transportation, social support, behaviors, health literacy, housing or food insecurity — impact the development and recovery of acute and chronic diseases. Social connections and hopefulness are qualitative components that are difficult to measure and are especially crucial to better understand – that data was collected in this particular study which is vitally important to conduct in the SBDoH space. Many patients reported physical, emotional, or other mental benefits associated with engaging in this intervention. Benefits included a better diet, decreased stress/worry, and increased feelings of stability.
We need to continue to explore if intermediate outcomes linked to developing therapeutic relationships (trust) can be used to assess the impact of SBDoH interventions in clinical settings.
By collecting data to represent and measure these attributes, we will better understand how trust and therapeutic relationships can be used to assess how social and behavioral interventions impact overall outcomes.
Q: As a result of these findings, what recommendations can you make to providers who are designing and optimizing social intervention programs in their communities?
A: Different clinical environments are at different places as they are entering or innovating within the SBDoH space. However, there needs to be a real commitment to measuring the impact of these interventions. In order to achieve the vision of truly patient-centered care, we need to prioritize identifying and assessing ways to overcome systemic and personal barriers that exist in patients’ communities.
These findings can improve the design and impact of interventions that connect primary care patients to community resources. Specifically, some patients in this analysis benefited from exploring and learning independently which indicates that some may benefit from engagements that emphasize activation and self-advocacy. When done well, social needs interventions connecting patients with social needs to community resources provide individuals with a therapeutic relationship that positively impacts the ability to solve problems and address barriers to their health and overall well-being.
Finally, there is a lot of power in applying qualitative findings and integrating the patient voice into quantitative research and analyses. Mixed methodologies combining qualitative and quantitative information have real potential to more accurately inform long term health outcomes and ensure the provision of patient-centered, whole-person care.