Provider Impacts of Socioeconomic Risk Screening and Referral Programs: A Scoping Review

Andrea Quiñones-Rivera; Holly E. Wing; Jill Barr-Walker; Megan Yee; Jessica M. Harrison; Laura M. Gottlieb

doi:10.3122/jabfm.2021.04.210039

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Figure 1.
PRISMA flow diagram of included studies in the review. Abbreviation: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

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Table 1.

Study Characteristics

Study Design

Study Setting

Target Social Need

Targeted Providers

Intervention studies

RCT ^25–27 (3)
Quasi-experimental with comparison group^{28–32,43,44} (7)
Quasi-experimental without comparison group ^{33–42,45–60} (26)

Nonintervention studies

Cross-sectional surveys, interviews, and focus groups^61–77 (17)

Primary care

Adult^{25,28,35,52,69} (5)
Pediatric^{26,27,32,34,39,40,43,44,53,56,58,70,72–74,76} (16)
Mixed/unknown^{33,42,51,54,60,61,65,68,71,77} (10)

Inpatient

Adult^41,48 (2)
Pediatric^29,33,50 (3)

Emergency department^49,63,67 (3)
Medical school^31,36,37,47 (4)
Multiple settings/other^{30,38,45,46,55,59,62,64,66,75} (10)

Multiple SDoH^{26–33,36–40,43,44,46,51,54,56,59–63,65–68,73–77} (33)
Food insecurity^{34,45,52,53,58,69,70,72} (8)
Health literacy^{25,41,42,47,48,57,71} (7)
Housing^35,49 (2)
Legal services^50,55 (2)
Other⁶⁴ (1)

Physicians^{25,28,33–35,39,45,50–54,56,58–70,72,75–77} (30)
Resident physicians^{25–27,29,30,32,39–46,51,55,58,63,66,73,74} (21)
Nurses^{48–50,53,55,57,60,67,75} (9)
Nurse practitioners^{35,39,52,53,69–71} (7)
Social workers^49,50,52,75 (4)
Community health workers/certified recovery specialists^33,37 (2)
Medical students^{31,36–38,45,47} (6)
Pharmacists⁷⁵ (1)
Clinic staff/other allied health professionals^{33,34,42,55,59,60,63,67,69} (9)

RCT, randomized controlled trials; SDoH, social determinants of health.

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Table 2.

Provider Outcomes Related to Social Care Activities in Clinical Settings

Knowledge

Attitudes and Beliefs

Behaviors

Prevalence/awareness of patients' social needs^{25,32,35,38,41,42,44,47,59,70,72,75}
Health impacts of social needs^{36,41,45,63,68,71}
Awareness of resources/referrals^{27,30,43–46,55–57,59,64,69,72,75}

Importance of SDoH^{30,31,35,44,45,61,62,65,67,73,75–77}
Acceptability of social care programs^{25,26,33,48–53,56,58,67,69–72,75}
Comfort identifying/addressing social need(s) ^{26,32,37,39,41,43,45,46,61,64–68,70,74–77}
Provider role in social care programs^{35,43,45,51,52,59,61–63,67,70,72,73,75}
Barriers to screening and referral program implementation^{32–35,39,43,52–56,58–64,66,69,70,72,75,76}

—Lack of time^{32,34,39,43,56,59,60,63,66,69,70,72,75}
—Lack of training/knowledge^{34,52,56,60,63,64,70,72,75,76}
—Lack of resources^{35,43,52–54,56,59–62,66,69,70,75}
—Lack of comfort screening^{43,61,64,70,72}
—Provider burden^{33,35,54,59,62,69,72}
—Patient discomfort^{33,34,53,55,56,58,60,70,72,75}
—Not appropriate in health setting^54,72

Effects on provider-patient relationship^{34,36,52–56,59,70,72,75}

Social risk screening rates/activities^{26,27,29,32,34,35,39,43–46,48,51,53,55,56,63,64,68–76}
Referral activities^{26,45,46,55,63,68}
Clinical care adjustment^{25,29,32,42,54,57,59,66,75}
Documentation^40,58,68
Time spent on intervention^26,39,74
Productivity²⁸