Building a Foundation to Reduce Health Inequities: Routine Collection of Sociodemographic Data in Primary Care

Abstract

Introduction: Detailed data on social determinants of health can facilitate the identification of inequities in access to health care. We report on a sociodemographic data collection tool used in a family medicine clinic.Methods: Four major health organizations in Toronto collaborated to identify a set of 14 questions that covered a range of social determinants of health. These were translated into 13 languages. This survey was self-administered using an electronic tablet to a convenience sample of 407 patients in the waiting room of a primary care clinic. Data were uploaded directly to the electronic medical record.Results: The rate of valid responses provided for each question was high, ranging from 84% to 100%. The questions with the highest number of patients selecting "do not know" and "prefer not to answer" pertained to disabilities and income. Patients reported finding the process acceptable. In subsequent implementation across 5 clinics, 10,536 patients have been surveyed; only 724 (6.9%) declined to participate.

Potential harms associated with routine collection of patient sociodemographic information: A rapid review

“…Of the 18 studies included in this review, 11 (61.1%) exclusively assessed patients’ perceptions or experiences of the harms associated with the routine collection of sociodemographic data . Four (22.2%) studies exclusively assessed providers’ perceptions of the potential harms for patients from the routine collection of sociodemographic data .…”

“…The included studies were conducted in the USA (66.7%), Canada (27.8%) and the UK (11.1%) . Three studies employed a mixed‐methods design, eight studies used a quantitative design, and the remaining seven used a qualitative design . Three studies included a large variety of racial/ethnic groups including white, black/African American, Latino/Hispanic, Asian and multiracial participants .…”

“…One study included only South Asians . Other studies included the general population and/or health‐care service users . One study (reported in two papers) included a range of participants including community leaders, health‐care workers, health‐care service users and health policy decision makers .…”

“…All 13 studies reporting patients’ perceptions or experiences assessed the harms associated with the collection of race/ethnicity/culture/language data . Three studies assessed the harms associated with the collection of income data, and two studies assessed the harms associated with the collection of religion data . Six studies reported patient perceptions, four reported patient experiences, and three reported both patient perceptions and experiences …”

Social Determinants of Health and Primary Care: Intentionality Is Key to the Data We Collect and the Interventions We Pursue

“…As a result of this work, the New Mexico Department of Health now requires managed care organizations to provide community health workers to Medicaid patients. Moving beyond Article, Pinto and his fellow researchers 11 found that asking patients to complete a 14-item survey on SDOHs using a tablet interface was both feasible and acceptable. Developing the survey, garnering staff buy-in, and achieving integration with the clinic's EHR took a significant amount of time.…”