Investigating Social Determinants of Health in an Urban Direct Primary Care Clinic

Tou, Leila C.; Prakash, Nirmala; Jeyakumar, Shereen J.; Ravi, Srekar

doi:10.7759/cureus.10791

Cited by 8 publications

(4 citation statements)

References 17 publications

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“…The questions from the validated PRAPARE survey examined income, housing situation, housing stability, household size and dependents, education, employment, insurance, social integration and support, transportation, stress, and material security ( 15 ). Complete results from the questionnaire were reported and analyzed in another study ( 16 ). Relevant sociodemographic data from the questionnaire was reported in this study to provide a broader understanding of the patient sample.…”

Section: Methodsmentioning

confidence: 99%

Understanding Patient Perceptions Towards Direct Primary Care: A Focus Group Study

Tou

Jeyakumar

Siddiqui

et al. 2022

Journal of Patient Experience

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Direct primary care (DPC) is a growing model of care that is suggested as an alternative to traditional fee-for-service healthcare. Patient-reported experiences of DPC can provide unique insight into the impact of joining the model and inform quality improvement. The purpose of this study was to investigate patient perceptions of DPC. Thirty-one participants were initially recruited for the study and completed a survey assessing patient demographics. Of the 31 participants, 10 went on to complete the focus group interviews. Qualitative analysis of focus group transcripts identified common themes and subthemes. Focus group findings were stratified into 4 themes including quality of care, access to care, affordability, physician qualities, and reasons for choosing DPC. The top positive subthemes were good communication, joining DPC due to poor past healthcare experiences, and physician personability. The most common negative subthemes were difficulty referring to specialists outside the practice, poor communication, and poor access to medications. All findings were presented and discussed with the investigated clinic to facilitate improvements in healthcare delivery.

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Section: Methodsmentioning

confidence: 99%

Understanding Patient Perceptions Towards Direct Primary Care: A Focus Group Study

Tou

Jeyakumar

Siddiqui

et al. 2022

Journal of Patient Experience

Self Cite

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“…In contrast, most items that assess Employment Exposure were highly contextualized (Level 3). • Ganguli et al tool [32] • Health Leads [33,34] • iScreen [37] • Patient Reported Outcome Quality of Life Tool (PROQoL) [40,41] • Reves et al tool [48] • Semple-hess et al tool [50] • Sokol et al tool [51] • The Online Advocate [53] • THRIVE [54] • WE CARE [58-63] • Tong et al tool [55] • Fleeger et al tool [30] • Flinders University Social Health History Screening Tool FUST [31] • PRAPARE [42][43][44][45][46] • Razani et al tool [47] Level • OHRA [39] • Schwartz et al tool [49] • Van Beukering et al tool [57] • Zachek et al tool [66]…”

Section: Level Of Contextualizationmentioning

confidence: 99%

Screening Tools for Employment in Clinical Healthcare Delivery Systems: A Content Analysis

Colon¹,

Goodman²

2023

Preprint

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Background The relationship between work and health is complex and bidirectional, where work can have both health-harming and health-enhancing effects. Though employment is recognized as a social determinant of health, and clinical healthcare delivery systems are increasingly using screening tools to ask patients about social needs, little research has explored the extent to which employment-related social risk is captured in these screening tools. This study aimed to identify and characterize employment- and work-related questions in social risk screening tools that have been implemented in clinical healthcare delivery systems. Methods We conducted a qualitative content analysis of employment-related items in screening tools that have been implemented in clinical healthcare service delivery systems. Three content areas guided data extraction and analysis: Setting, Domain, and Level of Contextualization. Results Screening tools that asked employment-related questions were implemented in settings that were diverse in the populations served and the scope of care provided. The intent of employment-related items focused on four domains: Social Risk Factor, Social Need, Employment Exposure, and Legal Need. Most questions were found to have a low Level of Contextualization and were largely focused on identifying an individual’s employment status. Conclusions Several existing screening tools include measures of employment-related social risk, but these items do not have a clear purpose and range widely depending on the setting in which they are implemented. In order to maximize the utility of these tools, clinical healthcare delivery systems should carefully consider what domain(s) they aim to capture and how they anticipate using the screening tools to address social determinants of health.

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“…The most frequent SDOH exposures determined by recent epidemiologic studies of national cohorts and smaller community clinics include depressive symptoms/perceived stress, lack of insurance, low education, unemployment, and lack of physical activity (Kusnoor et al., 2018; Tou, Prakash, Jeyakumar, & Ravi, 2020; Weir et al., 2020). A nationwide survey observed an average of 7 social risks reported by adults (out of 22 screened).…”

Section: Measurement Of Sdoh Factors In Research and Clinical Settingsmentioning

confidence: 99%

Inclusion of Social and Structural Determinants of Health to Advance Understanding of their Influence on the Biology of Chronic Disease

et al. 2022

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Social Determinants of Health (SDOH) consider social, political, and economic factors that contribute to health disparities in patients and populations. The most common health-related SDOH exposures are food and housing insecurity, financial instability, transportation needs, low levels of education, and psychosocial stress. These domains describe risks that can impact health outcomes more than health care. Epidemiologic and translational research demonstrates that SDOH factors represent exposures that predict harm and impact the health of individuals. International and national guidelines urge health professionals to address SDOH in clinical practice and public health. The further implementation of these recommendations into basic and translational research, however, is lagging. Herein, we consider a precision health framework to describe how SDOH contributes to the exposome and exacerbates physiologic pathways that lead to chronic disease. SDOH factors are associated with various forms of stressors that impact physiological processes through epigenetic, inflammatory, and redox regulation. Many SDOH exposures may add to or potentiate the pathologic effects of additional environmental exposures. This overview aims to inform basic life science and translational researchers about SDOH exposures that can confound associations between classic biomedical determinants of disease and health outcomes. To advance the study of toxicology through either qualitative or quantitative assessment of exposures to chemical and biological substances, a more complete environmental evaluation should include SDOH exposures. We discuss common approaches to measure SDOH factors at individual and population levels and review the associations between SDOH risk factors and physiologic mechanisms that influence chronic disease. We provide clinical and policy-based motivation to encourage researchers to consider the impact of SDOH exposures on study results and data interpretation. With valid measures of SDOH factors incorporated into study design and analyses, future toxicological research may contribute to an evidence base that can better inform prevention and treatment options, to improve equitable clinical care and population health.

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Investigating Social Determinants of Health in an Urban Direct Primary Care Clinic

Cited by 8 publications

References 17 publications

Understanding Patient Perceptions Towards Direct Primary Care: A Focus Group Study

Understanding Patient Perceptions Towards Direct Primary Care: A Focus Group Study

Screening Tools for Employment in Clinical Healthcare Delivery Systems: A Content Analysis

Inclusion of Social and Structural Determinants of Health to Advance Understanding of their Influence on the Biology of Chronic Disease

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