Exploratory study of “real world” implementation of a clinical poverty tool in diverse family medicine and pediatric care settings

Abstract

BackgroundPoverty is associated with increased morbidity related to multiple child and adult health conditions and increased risk of premature death. Despite robust evidence linking income and health, and some recommendations for universal screening, poverty screening is not routinely conducted in clinical care.MethodsWe conducted an exploratory study of implementing universal poverty screening and intervention in family medicine and a range of pediatric care settings (primary through tertiary). After attending a training session, health care providers (HCPs) were instructed to perform universal screening using a clinical poverty tool with the question “Do you ever have difficulty making ends meet at the end of the month?” for the three-month implementation period. HCPs tracked the number of patients screened and a convenience sample of their patients were surveyed regarding the acceptability of being screened for poverty in a healthcare setting. HCPs participated in semi-structured focus groups to explore barriers to and facilitators of universal implementation of the tool.ResultsTwenty-two HCPs (10 pediatricians, 9 family physicians, 3 nurse practitioners) participated and 150 patients completed surveys. Eighteen HCPs participated in focus groups. Despite the self-described motivation of the HCPs, screening rates were low (9% according to self-reported numbers). The majority of patients either supported (72%) or were neutral (22%) about the appropriateness of HCPs screening for and intervening on poverty. HCPs viewed poverty as relevant to clinical care but identified time constraints, physician discomfort, lack of expertise and habitual factors as barriers to implementation of universal screening.ConclusionsPoverty screening is important and acceptable to clinicians and patients. However, multiple barriers need to be addressed to allow for successful implementation of poverty screening and intervention in health care settings.

Implementation of Targeted Screening for Poverty in a Large Primary Care Team in Toronto, Canada: a feasibility study

“…Although physicians welcomed screening tools, the authors noted that screening was likely not feasible if the physician was solely responsible, and recommended a team based approach (14). A recent study of universal screening in "real world" primary care settings reported that 9% of patients had been screened (24). Participating physicians were self-selected early adopters, committed to the process; 28% of patients screened positive, possibly indicating some targeting of patients.…”

“…However, in Canada, screening for poverty is not currently a routine part of family practice, with some exceptions (23). Barriers include lack of provider training, lack of time, lack of knowledge and expertise, and di culty changing work ows (24,25). There may be multiple competing priorities as family physicians look after many issues and conditions that require attention.…”

“…However, these sites had a mandate to address social inequities as a priority, practice populations with high levels of poverty, dedicated champions and resources devoted to the intervention. An exploratory study in a variety of "real world" primary care settings found that only 9% of patients were screened, despite training and the presence of motivated healthcare providers (24).…”

Should we screen for poverty in primary care?

“…Data 5 from 22 Canadian healthcare professionals have suggested that using the question 'Do you have difficulty making ends meet at the end of the month?' is acceptable to 75% of those patients who responded to the questionnaire (n = 56, 100% response rate).…”

Implementation of Targeted Screening for Poverty in a Large Primary Care Team in Toronto, Canada: A Feasibility Study

“…However, in Canada, screening for poverty is not currently a routine part of family practice, with some exceptions (23). Barriers include lack of provider training, lack of time, lack of knowledge and expertise, and di culty changing work ows (24,25). There may be multiple competing priorities as family physicians look after many issues and conditions that require attention.…”