Insights Into Patients' Perceptions of Health-Related Social Needs and the Role of the Adult Primary Care Clinic

Kerry K Meltzer; Corinne M Rhodes; Anna U Morgan; Gillian L Lautenbach; Judy A Shea; Marguerite A Balasta

doi:10.1177/21501319231184380

Insights Into Patients' Perceptions of Health-Related Social Needs and the Role of the Adult Primary Care Clinic

J Prim Care Community Health. 2023 Jan-Dec:14:21501319231184380. doi: 10.1177/21501319231184380.

Authors

Kerry K Meltzer^{1

2

3}, Corinne M Rhodes⁴, Anna U Morgan^{3

4}, Gillian L Lautenbach⁴, Judy A Shea⁴, Marguerite A Balasta⁴

Affiliations

¹ National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA, USA.
² Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
³ Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

Abstract

Introduction/objectives: While it is well established that unmet healthrelated social needs (HRSN) adversely affect health outcomes, there has been limited evaluation in adult primary care of patients' perceptions of how these needs impact their health and the role of the primary care provider (PCP). The objective of this study is to identify patients' perceptions of HRSN and how PCPs could help address them. Secondary objectives include exploring the impact of goal setting and a 1-time cash transfer (CT).

Methods: This qualitative study used semi-structured baseline and follow-up interviews with patients in internal medicine clinics. Adult primary care patients were included if they screened positive as having 1 of 3 HRSN: financial resource strain, transportation needs, or food insecurity. All participants completed an initial interview about their HRSN and health, and were asked to set a 6-month health goal. At enrollment, participants were randomized to receive a $500 CT or a $50 participation reward. At 6-months, patients were interviewed again to investigate progress toward meeting their health goals, [when applicable] how the CT helped, and their beliefs about the role of PCPs in addressing HRSN.

Results: We completed 30 initial and 25 follow-up interviews. Participants identified their HRSN, however most did not readily connect identified needs to health. Although participants were receptive to HRSN screening, they did not feel it was their PCP's responsibility to address these needs. Verbal goal-setting appeared to be a useful tool, and while the CTs were appreciated, patients often found them inadequate to address HRSN.

Conclusions: Given the importance of identifying the social conditions that shape patients' health, providers, and health systems have an opportunity to re-evaluate their role in helping patients address these barriers. Future studies could examine the effect of more frequent disbursement of CTs over time.

Keywords: cash transfer; perceptions; primary care; social determinants of health; social needs.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Ambulatory Care Facilities*
Emotions
Humans
Patients
Primary Health Care