Relationship Between Unmet Social Needs and Care Access in a Veteran Cohort

Abstract

Background The association between unmet social needs (e.g., food insecurity) and adverse health outcomes is well-established, especially for patients with and at risk for cardiovascular disease (CVD). This has motivated healthcare systems to focus on unmet social needs. Yet, little is known about the mechanisms by which unmet social needs impact health, which limits healthcare-based intervention design and evaluation. One conceptual framework posits that unmet social needs may impact health by limiting care access, but this remains understudied. Objective Examine the relationship between unmet social needs and care access. Design Cross-sectional study design using survey data on unmet needs merged with administrative data from the Veterans Health Administration (VA) Corporate Data Warehouse (September 2019–March 2021) and multivariable models to predict care access outcomes. Pooled and separate rural and urban logistic regression models were utilized with adjustments from sociodemographics, region, and comorbidity. Subjects A national stratified random sample of VA-enrolled Veterans with and at risk for CVD who responded to the survey. Main Measures No-show appointments were defined dichotomously as patients with one or more missed outpatient visits. Medication non-adherence was measured as proportion of days covered and defined dichotomously as adherence less than 80%. Key Results Greater burden of unmet social needs was associated with significantly higher odds of no-show appointments (OR = 3.27, 95% CI = 2.43, 4.39) and medication non-adherence (OR = 1.59, 95% CI = 1.19, 2.13), with similar associations observed for rural and urban Veterans. Social disconnection and legal needs were especially strong predictors of care access measures. Conclusions Findings suggest that unmet social needs may adversely impact care access. Findings also point to specific unmet social needs that may be especially impactful and thus might be prioritized for interventions, in particular social disconnection and legal needs.

Understanding the causes of missingness in primary care: a realist review

“…Patients experiencing missingness may be positioned in precarious socioeconomic circumstances that expose them to disruptive forces that threaten health, material and social wellbeing [ 9 , 11 , 17 – 19 , 43 , 49 , 59 , 62 , 65 , 71 , 96 , 103 ]. Ideas of competing demands or “conflicting candidacies”([ 79 ], p.56) shows how multiple urgent and competing priorities might result in reduced prioritisation of health or appointment attendance relative to other needs [ 30 , 32 , 36 , 40 , 50 , 55 , 57 , 59 , 62 , 82 , 83 , 99 , 102 , 103 , 107 , 121 – 128 ].…”

“…These demands include treatment burden and other appointments [ 4 , 10 , 11 , 15 , 17 , 19 , 28 , 41 , 43 , 44 , 48 , 59 , 61 , 62 , 64 , 73 , 83 , 84 , 86 , 93 , 100 , 128 – 135 ]; employment responsibilities, employer inflexibility and the financial costs of missing work [ 11 , 40 , 44 , 46 – 49 , 59 , 64 , 81 , 106 , 107 , 109 , 115 , 123 , 135 – 137 ]; and caring responsibilities taking precedence [ 14 , 40 , 41 , 44 , 48 , 59 , 64 , 99 , 131 , 138 ]. Patients experiencing severe and multiple disadvantages may have to prioritise accommodation, physical safety and survival demands over healthcare [ 43 , 48 , 53 , 64 , 65 , 69 , 71 , 81 , 96 , 103 , 114 , 139 ]. Travelling to appointments requires resources that may be limited or needed to meet other demands [ 27 , 28 , 30 –…”

“…Travelling to appointments requires resources that may be limited or needed to meet other demands [ 27 , 28 , 30 – 32 , 36 , 39 , 40 , 47 , 55 , 56 , 83 , 90 , 125 , 126 , 140 ]. Disabilities or severe physical or mental health symptoms can make travelling to appointments unsafe or unmanageable [ 8 , 9 , 13 , 15 , 30 – 32 , 36 , 40 , 41 , 44 – 50 , 54 , 55 , 58 , 60 – 62 , 64 , 65 , 68 , 82 , 84 , 86 , 89 , 90 , 96 , 99 , 100 , 103 , 105 – 110 , 122 , 125 , 126 , 128 , 129 , 133 , 141 – 150 ]. Social connections and their resources may be beneficial but are not always available to help [ 11 , 44 , 45 , 48 , 49 , 62 , 63 , 65 , 101 , 103 , 112 , 122 , ...…”

“…Some designs actively exclude relevant patient groups—for example, those with existing mental health issues, cognitive impairments, learning disabilities or who do not speak English [ 46 , 48 , 60 – 64 ]. Other methods are indirectly exclusionary, such as reliance on single, monolingual postal surveys, which may disadvantage those with no fixed address or who have literacy or language needs [ 45 , 65 , 66 ]. Research, like healthcare, has a “missingness” problem to address [ 45 , 66 ].…”

Feasibility of Using Text Messaging to Identify and Assist Patients With Hypertension With Health-Related Social Needs: Cross-Sectional Study

“…Studies assessing the use of mobile tools (eg, tablets) and telephone-based screening identified barriers to these screening modalities [ 12 - 14 ]. Barriers to using these methods include that tablets are dependent on patients presenting in person to the clinic [ 12 , 15 , 16 ] and phone-based screening may add additional work for already busy clinical staff [ 14 ].…”