Article Figures & Data
Tables
- Table 1.
Comparison of Baseline Characteristics of All Patients with Diabetes with a Social Work Consultation in 2014 at Three Primary Care Sites in One Health System vs. a Subgroup of Patients Randomly Selected for Medical Record Abstraction
Patients with Diabetes with a Social Work Consultation in 2014 (n = 977)* n (%) or Mean (SD) Patients with Diabetes with a Social Work Consultation in 2014 Randomly Selected for Medical Record Abstraction (n = 300)† n (%) or Mean (SD) P Value Female sex, n (%) 569 (58) 194 (65) .05 Race, n (%) .16 Black 623 (64) 175 (58) White 316 (32) 108 (36) Other 38 (4) 17 (6) Insurance type, n (%) 1.00 Medicare 510 (52) 154 (51) Medicaid 311 (32) 88 (29) Commercial 75 (8) 20 (7) Other 89 (9) 38 (13) Age (years), Mean (SD) 60.7 (13.6) 60.8 (13.3) .90 HbA1c (%), Mean (SD) 7.8 (2.2) 7.9 (2.1) .37 LDL cholesterol (mg/dL), Mean (SD) 97.2 (38.9) 96.3 (39.4) .76 SBP (mmHg), Mean (SD) 132.9 (20.9) 131.5 (18.8) .31 BMI (kg/m2), Mean (SD) 33.7 (9.3) 34 (9.7) .30 ↵* Of the 977 patients, 382 were from clinic 1 (urban), 342 were from clinic 2 (urban), and 253 were from clinic 3 (rural). A total of 908 patients had data for glycosylated hemoglobin (HbA1c), 884 patients had data for low-density lipoprotein (LDL) cholesterol, 974 patients had data for systolic blood pressure (SBP), and 958 patients had data for body mass index (BMI).
↵† Of the 300 patients, 100 were from clinic 1 (urban), 100 were from clinic 2 (urban), and 100 were from clinic 3 (rural).
BMI, body mass index; HbA1c, glycosylated hemoglobin; LDL, low-density lipoprotein; n, number; SBP, systolic blood pressure; SD, standard deviation.
- Table 2.
Social Determinants of Health Addressed for 300 Patients Seen by a Social Worker at Three Primary Care Sites in 2014
SDH Classification Established by Wilkinson and Marmot1 Patients for Whom the SDH Was Addressed (N = 300)* Examples from Social Work Note Social Gradient: impact of monetary assets, occupational security/level, and housing circumstances 200 (67) • Assisted patient in applying for medication assistance program • Assisted patient in completing Medicaid application • Provided patient information regarding subsidized housing • Directed patient to financial assistance program for aid in affording home utilities Social Support: impact of reliable emotional and tangible support systems 75 (25) • Assessed patient's support system for daily activities • Connected patient to home care nursing assistance • Discussed with patient their sources of emotional support Transport: the means to access the health system and exercise in safe environments 43 (14) • Arranged patient's transportation to and from physician appointments via hospital van • Assisted patient in completing application for cost-subsidized public transportation Psychiatric Issues: need for referral to mental health provider† 37 (12) • Referred patient to on-site psychiatrist • Referred patient to off-site counselor Unemployment: increased risk of premature death 14 (5) • Discussed patient's recent unemployment and future employment goals • Provided patient information in renewing occupational license • Assisted patient in obtaining proof of disability Food: access to affordable healthy options 12 (4) • Encouraged patient to apply for food stamps • Educated patient regarding different home meal services Stress: effects of anxiety, insecurity, low self-esteem 11 (4) • Briefly discussed patient's stress coping mechanisms • Listened to patient describe stress of difficult marriage Social Exclusion: effects of discrimination, debilitation, racism, stigmatization 8 (3) • Discussed patient's difficulties upon recent release from prison • Referred patient struggling with blindness to support center to help increase quality of life Addiction: impact of alcohol, nicotine, and drug dependence 6 (2) • Discussed different smoking cessation resource options • Referred patient to on-site alcohol specialist Work: impact of stress at work 3 (1) • Provided patient information regarding job retraining opportunities following patient's recent injury Early Life: impact of emotional and developmental experiences of childhood and adolescence 2 (1) • Discussed how patient was affected by early relationships with family members • Discussed patient's journey as an immigrant to this country - Table 3.
Measures of Diabetes and Cardiovascular Risk Factor Control for Patients with a Social Work Consultation in 2014 and with Values at Both Baseline and at Least 3-Month Follow-up
Measures of Diabetes and Cardiovascular Risk Factor Control Patients with Clinical Values at Baseline and Follow-up Baseline* Follow-up† P Value Mean HbA1c (%) 576 7.8 7.9 .97 Mean LDL cholesterol (mg/dL) 345 97.2 94.3 .48 Mean SBP (mmHg) 866 132.9 133.5 .72 Mean BMI (kg/m2) 839 33.7 33.8 .69 ↵* The last biometric value or test result recorded before the first SW encounter in 2014.
↵† The first biometric value or test result recorded at least 3 months after the first SW encounter in 2014.
BMI, body mass index; HbA1c, glycosylated hemoglobin; LDL, low-density lipoprotein; SBP, systolic blood pressure; SW, social work.
- Table 4.
Measures of Diabetes and Cardiovascular Risk Factor Control at Baseline and at Least 3-Month Follow-up for the Subsets of Patients with Glycosylated Hemoglobin >9%, Low-Density Lipoprotein Cholesterol >130 mg/dL, Systolic Blood Pressure >160 mmHg, or Body Mass Index >30 kg/m2 Before the First social Work Consultation: Intervention Group vs. Comparison Group
Measures of Diabetes and Cardiovascular Risk Factor Control Matched Pairs (n) Baseline* Follow-up† Mean Change for Each Patient Intervention Group Comparison Group P Value Intervention Group Comparison Group P Value Intervention Group Comparison Group P Value HbA1c (%) 188 11.2 11.1 .48 9.5 10.0 .02 −1.5 −1.1 .03 LDL cholesterol (mg/dL) 125 155.9 155.5 .71 121.9 134.2 .01 −37.7 −21.3 .002 SBP (mmHg) 89 175.1 173.5 .28 149.8 149.1 .80 −24.8 −25.5 .996 BMI (kg/m2) 523 39.2 38.2 .14 39.0 37.9 .19 −0.4 −0.3 .18 ↵* Last biometric value or test result recorded before the first social work (SW) encounter (or dummy visit) in 2014.
↵† First biometric value or test result recorded at least 3 months after the first SW encounter (or dummy visit) in 2014.
BMI, body mass index; HbA1c, glycosylated hemoglobin; LDL, low-density lipoprotein; SBP, systolic blood pressure.
Variables Comparison Group (n = 188) Intrevention Group (n = 188) P Value Sex, n (%) .84 Female 88 (46.8) 90 (47.9) Male 100 (53.2) 98 (52.1) Race .81 Black 119 (63.3) 125 (66.5) Other 8 (4.3) 7 (3.7) White 61 (32.4) 56 (29.8) Insurance type, n (%) .94 Private 24 (12.8) 20 (10.6) Medicare 82 (43.6) 84 (44.7) Medicaid 74 (39.4) 76 (40.4) Self-pay 8 (4.3) 8 (4.3) Age (years) .89 Minimum 20.6 23.8 Q1 48.1 48.7 Median 56.4 56.5 Q3 64.1 64.7 Maximum 87.2 87.3 Mean 56.1 56.4 SD 13.9 12.9 HbA1c (%) .48 Minimum 9 9 Q1 9.7 9.9 Median 10.7 10.8 Q3 12.1 12 Maximum 17.2 17.3 Mean 11.1 11.2 SD 1.7 1.7 Income ($) .23 Minimum 11,792 11,792 Q1 23,161 24,312 Median 31,918.5 35,110 Q3 46,475 46,475 Maximum 72,010 72,010 Mean 34,719.1 35,877.1 SD 13,734.2 12,337.8 HbA1c, glycosylated hemoglobin; SD, standard deviation.
Variables Comparison Group (n = 523) Intrevention Group (n = 523) P Value Sex, n (%) .70 Female 321 (61.4) 327 (62.5) Male 202 (38.6) 196 (37.5) Race, n (%) .25 Black 325 (62.1) 326 (62.3) Other 6 (1.1) 13 (2.5) White 192 (36.7) 184 (35.2) Insurance type, n (%) .23 Private 61 (11.7) 42 (8) Medicare 273 (52.2) 274 (52.4) Medicaid 182 (34.8) 200 (38.2) Self-pay 7 (1.3) 7 (1.3) Age (years) .78 Minimum 21.8 21.8 Q1 49.5 49.5 Median 58.6 57.1 Q3 68.4 67.7 Maximum 89.7 92 Mean 58.4 58.4 SD 13.3 13.2 BMI (kg/m2) .14 Minimum 30 30 Q1 32.6 33 Median 36.7 37.4 Q3 41.6 43 Maximum 61.7 78 Mean 38.2 39.2 SD 6.7 8 Income ($) .44 Minimum 14,227 11,792 Q1 23,205 23,205 Median 36,356 35,833 Q3 46,475 46,475 Maximum 98,260 90,599 Mean 36,927 36,017.7 SD 14,314 13,487 BMI, body mass index; SD, standard deviation.
Variables Comparison Group (n = 89) Intrevention Group (n = 89) P Value Sex, n (%) .54 Female 55 (61.8) 51 (57.3) Male 34 (38.2) 38 (42.7) Race, n (%) .57 Black 69 (77.5) 72 (80.9) Other 0 (0) 1 (1.1) White 20 (22.5) 16 (18) Insurance type, n (%) .96 Private 8 (9) 8 (9) Medicare 63 (70.8) 60 (67.4) Medicaid 16 (16) 19 (21.3) Self-pay 2 (2.2) 2 (2.2) Age (years) .37 Minimum 23.8 29.1 Q1 56.9 54.9 Median 66.4 63 Q3 75 74.7 Maximum 89.7 91.4 Mean 65.1 63.8 SD 13.7 14 SBP (mmHg) .28 Minimum 160 160 Q1 164 166 Median 168 170 Q3 180 182 Maximum 215 230 Mean 173.5 175.1 SD 13 13.7 Income ($) .43 Minimum 19,371 11,792 Q1 24,312 23,205 Median 31,481 31,120 Q3 46,475 46,241 Maximum 98,260 72,010 Mean 35,511.6 33,427 SD 13,615.4 12,801.5 SBP, systolic blood pressure; SD, standard deviation.
Variables Comparison Group (n = 125) Intrevention Group (n = 125) P Value Sex, n (%) .52 Female 72 (57.6) 77 (61.6) Male 53 (42.4) 48 (38.4) Race, n (%) .95 Black 80 (64) 82 (65.6) Other 5 (4) 4 (3.2) White 40 (32) 39 (31.2) Insurance type, n (%) .91 Private 7 (5.6) 6 (4.8) Medicare 76 (60.8) 74 (59.2) Medicaid 42 (33.6) 45 (36) Self-pay 0 (0) 0 (0) Age (years) .18 Minimum 29.9 30.4 Q1 53.7 51.3 Median 62.4 57.9 Q3 69.3 68.2 Maximum 89.9 85.5 Mean 61.8 59.8 SD 12.6 11.8 LDL cholesterol (mg/dL) .71 Minimum 130 130 Q1 136 136 Median 145 148 Q3 166 165 Maximum 273 301 Mean 155.5 155.9 SD 28.4 28.9 Income ($) .63 Minimum 14,227 11,792 Q1 23,205 24,312 Median 31,481 37,594 Q3 46,475 46,475 Maximum 64,200 72,010 Mean 35,252.9 35,826.9 SD 13,015.4 12,902.5 LDL, low-density lipoprotein; SD, standard deviation.
