Patient Barriers to Accessing Referred Resources for Unmet Social Needs

Abstract

Introduction: Many primary care clinics screen patients for their unmet social needs, such as food insecurity and housing instability, and refer them to community-based organizations (CBOs). However, the ability for patients to have their needs met is difficult to evaluate and address. This study explores patient-reported barriers to accessing referred resources using a conceptual framework that identifies opportunities for intervening to optimize success.Methods: Patients who participated in a social needs screening and referral intervention at a Federally Qualified Health Center (FQHC) were called 2 weeks after the clinic encounter. We conducted a directed content analysis across 6 domains of access to examine responses from patients who reported barriers.Results: Of the 462 patients that were reached for follow-up, 366 patients reported 537 total barriers. The most frequent challenges related to resource availability (24.6%, eg, patients waiting for submitted application to process) and approachability (23.8%, eg, patients lacking information needed to contact or access resources). Barriers in the domains of acceptability (21.6%, eg, competing life priorities such as medical issues, major life events, or caretaking responsibilities) and appropriateness (17.9%, eg, resource no longer needed) largely represented patient constraints expressed only after the clinical encounter. It was less common for patients to identify accommodation (eg, physical limitations, language barriers, transportation barriers, administrative complexity) or affordability of community resources as barriers (11.2% and 0.9%, respectively).Conclusion: Findings suggest opportunities for improvement across the access continuum, from initial referrals from primary care staff during the clinical encounter to patients' attempts to accessing services in the community. Future efforts should consider increased collaboration between health and social service organizations, and advocacy for structural changes that mitigate system-level barriers related to resource availability and administrative complexity.

Training student volunteers as community resource navigators to address patients' social needs: A curriculum toolkit

“…Our work has resulted in four student-led, peer-reviewed publications and eight presentations at state, national, international conferences focused on the development and implementation of the Help Desk model, adaptations of the program during the pandemic, evaluating factors associated with a successful patient referral, and patient-reported barriers to accessing referred resources ( 15 – 17 , 29 ).…”

A Tailored SMS Text Message–Based Intervention to Facilitate Patient Access to Referred Community-Based Social Needs Resources: Protocol for a Pilot Feasibility and Acceptability Study

“…This intervention has the potential to provide a valuable touch point for patients seeking to navigate a complex and often fragmented system of health and social services. For patients, SMS text messaging may be a convenient, affordable, and accessible modality to deliver information and reminders about referred services, improving upon solely verbal dissemination methods that create patient-reported approachability barriers (eg, forgetting about resources and lacking the necessary information to connect) [ 12 ]. If feasible and acceptable to patients, SMS text messaging may also offer a scalable means of increasing contact between patients and their care teams without overextending organizational capacity, allowing providers to direct their case management efforts to those cases where more intensive approaches would be most valuable.…”

“…During these meetings, frontline clinical stakeholders relayed patient requests for the incorporation of SMS into the existing social needs program. The potential benefits of an SMS text message–based intervention were further bolstered by studies of patient-reported barriers [ 12 ] and low proportions of resource connection (33%) [ 10 ] at the FQHC. With stakeholder support, a convenience sample of 16 patients was surveyed about SMS text messaging during navigator follow-up calls: 87.5% of patients stated that they were comfortable with receiving SMS text messages about referred social needs resources, and 56.3% of them even preferred to receive this information via SMS text message rather than by telephone or in person.…”

“…Therefore, it is critical to design scalable interventions that address barriers and facilitate service access. In particular, patient-reported barriers related to engaging with referred resources suggest that different modes of information delivery may be important to explore [ 12 ].…”

Coordination challenges and promising practices for pediatric healthcare‐community partnerships: A multi‐site study

“…The wording of screening questions and the amount of paperwork involved, along with mistrust, perceived stigma, and negative prior experiences seeking resources disproportionately pose barriers to engagement with clinic‐based screening and referral for people of color and historically marginalized groups (Spain et al, 2021; Pfeiffer et al, 2022; Ronis et al, 2022). Service access poses its own set of inequities (Gadson et al, 2017; Lee & Rispoli, 2017; Sandhu et al, 2022). Identifying practices and strategies to support healthcare and early childhood partners to screen and coordinate service provision in different clinic and community contexts can inform the future efforts to spread and scale clinic‐based approaches to mitigating health disparities and addressing negative SDH.…”