Differences in Pediatric Residents’ Social Needs Screening Practices Across Health Care Settings

Abstract

The American Academy of Pediatrics recommends that all pediatricians screen for social determinants of health to identify families in need and connect them to available resources. We examined pediatric residents' screening practices for social needs in different clinical settings and explored the influence of electronic health record (EHR) prompts on screening. METHODS:In this cross-sectional study, pediatric residents participated in a brief electronic survey assessing (1) screening practices for unmet social needs and (2) perceived barriers to and facilitators of routine screening in the inpatient and outpatient settings. The differences in screening by care setting were assessed by using Fisher's exact test. Mixed-effects logistic regression was used to examine the association between EHR prompts and resident screening practices.RESULTS: Ninety-two pediatric residents (64% of the residency program) responded to the survey. Respondents reported significantly higher rates of social needs screening in the outpatient as compared with the inpatient setting (98% vs 37%; P , .001). Residents cited time constraints, lack of knowledge about available resources, and discomfort with screening questions as barriers to screening in both settings. Residents were more likely to screen for social needs when screening questions were embedded in the EHR (odds ratio 5 9.6; 95% confidence interval: 6.7-13.9). CONCLUSIONS: Pediatric residents were more likely to screen for unmet social needs in the outpatient than in the inpatient setting despite reporting similar barriers to screening in both settings. EHR-based social needs screening templates could be used to increase rates of screening and reach additional families in need.

Exploring the readiness of senior doctors and nurses to assess and address patients’ social needs in the hospital setting

“…A recent systematic review by Quiñones-Rivera and colleagues [19] found that providers held generally positive attitudes and beliefs about the importance of addressing social needs, however, they identified barriers to social needs screening including concerns regarding patient discomfort at being questioned, increasing pressure on time and workflow, risk to patient-provider relationships, and a lack of knowledge about how to address identified social needs [19]. A number of studies focused on the readiness of doctors and nurses in primary healthcare settings [3,17,[26][27][28]. One study identified disparities in screening rates between healthcare providers in the outpatient and inpatient settings, finding that a greater proportion of paediatric residents screened for social needs in the outpatient setting compared to those in the inpatient setting [28].Interestingly, paediatric residents cited the same barriers (time constraints, lack of knowledge, perceived patient discomfort) in both outpatient and inpatient settings [28].…”

“…A number of studies focused on the readiness of doctors and nurses in primary healthcare settings [3,17,[26][27][28]. One study identified disparities in screening rates between healthcare providers in the outpatient and inpatient settings, finding that a greater proportion of paediatric residents screened for social needs in the outpatient setting compared to those in the inpatient setting [28].Interestingly, paediatric residents cited the same barriers (time constraints, lack of knowledge, perceived patient discomfort) in both outpatient and inpatient settings [28].…”

Realizing the Potential of Social Determinants Data: A Scoping Review of Approaches for Screening, Linkage, Extraction, Analysis and Interventions

“…Studies targeted a diverse range of populations. For example, children were the focus in some studies [32,36], while adults were the primary subjects in studies [33,37]. Various healthcare settings were represented, from primary care clinics [38,39] to emergency departments [40], as well as school-based clinics [34] indicating the widespread recognition of the importance of SDoH in different medical environments, underscoring the growing acknowledgment of SDoH’s relevance across the healthcare spectrum.…”

Pediatric primary care provider and staff perspectives on the implementation of electronic health record-based social needs interventions: A mixed-methods study

“…Integration of these questionnaires would allow structured EHR documentation of patient SDoH with minimal impact on patient burden and clinical workload. Participants also suggested embedding the SDoH module items in existing well-child encounter note templates, a method that has shown success in other settings [17,47]. While these strategies are promising, the deployment of these modifications requires leadership buy-in, healthcare system prioritization, and information technology (IT) resource allocation.…”