Article Figures & Data
Figures
- Figure 1.
Focus group themes and subthemes.
Tables
- Table 1.
Participant Feedback and Quotations on Theme 1, “Barriers to Routine Screening of Health-Related Social Needs [HRSN] in Primary Care,” from Focus Groups Conducted from September to October 2022 in a Primary Care Setting at a Texas Academic Medical Center
Subtheme Quotation Time “It's going to be us [clinicians] feeling like we're rushing through things that are very personal to them [patients].” “It takes 5 to 10 minutes to just to find things [resources].” “I want to do something immediately to try to help [the patient]. And that will slow things down a lot in the clinic as well.” Workload burden “Right now part of the difficulty is our clinical staff is also really overworked and busy, and they're trying to do a lot of things as well, too, which tires them out.” “So with the workload that we [social workers] currently have, and—I can tell you, all of us are running ourselves ragged—common screening is going to dramatically increase our workload.” Emotional toll Sometimes a patient situation “grabs ahold of your heart strings, and you just go home and you're like, ‘Did I do everything I could do? Was there something I could have done differently?’” “If it's someone telling me, ‘I cannot put food on my table tomorrow,’ for me, that instantly triggers feelings of alarm and panic.” Fear of inadequacy “If I ask them about it [HRSN], I feel like they’re going to want an answer from me on what to do about it, and I’m not qualified to give them that kind of answer.” “If we're going to address these things [HRSN], then we have to be able to help [patients].” “If we just go, ‘Do you have this? Do you have this? Do you have this? Do you have that?’ And they say, ‘No, no, no, no.’ ‘Well, I can’t talk about it today.’ That makes them feel like, ‘I wasn’t heard.’” “It could negatively impact your relationship with [the patient] because they’re thinking you’re thinking of this as a very cavalier type thing and not a personal thing to them…” Patient-related factors “’Do you know how to navigate the Internet? Do you have a smartphone?’ Because yeah, not everybody's got access to those things and they're like, ‘No, don't, don't send me anything because I don't have a printer.’” “You have to have a relationship with the patient before they open up and tell about… especially partner violence or financial issues.” “They think, ‘Oh, well, someone is worse off than what I am… my lights are off, but I have food,’ …so, they don't recognize [their eligibility for assistance].” “Some of the patients are proud, and they don’t want to say that ‘I don't have food in the house.’ They wouldn’t say, ‘I can't afford this.’” “Patients don’t know that they can talk to us about issues like, ‘I don't have food.’ They are very accustomed to go to the doctor just for medicine.” “There's a big deficit in resources when someone's not a citizen, or in particular if they’re not here legally.” “A lot of this is personal, and patients aren’t even forthcoming sometimes when you ask them.” - Table 2.
Participant Feedback and Quotations on Theme 2, “the Benefit of Routine Screening for Health-Related Social Needs in Primary Care,” from Focus Groups Conducted from September to October 2022 in a Primary Care Setting at a Texas Academic Medical Center
Subtheme Quotation Improved care team awareness of the patient's context “Their health is important to them. But if they don’t have food to eat or they don’t have the transportation to get to that doctor’s appointment, that’s the concern at that moment.” “Maybe there’s something else going on behind the scenes that is affecting their motivation or willingness to actually be compliant with their medications or seek care for themselves.” “It does, for me at least, affect how I process their care or how I prioritize the patient’s needs… I may not be able to fix your food insecurity. I may not be able to fix transportation. But then it does make me think, ‘Let’s do longer follow-ups. Is this someone that telemedicine would be an option for?’… Having that information is useful, even if I can’t 100% resolve the problem for them.” “I’m not here to just put a Band-Aid on your finger. We’re here to address everything.” Improved patient-care team relationships and communications “Once I start kind of getting into a couple of questions, they start seeing the value in that, and then they kind of really open up. And then at the end of the visit – I love this part – and it’s like, ‘Wow, you guys really took care of me today!’” “[Patients are] thrilled that you actually spent that time and actually show that you cared.” - Table 3.
Participant Feedback and Quotations on Theme 3, “Recommendations for Screening and Interventions for Health-Related Social Needs,” from Focus Groups Conducted from September to October 2022 in a Primary Care Setting at a Texas Academic Medical Center
Subtheme Quotation Workflow and process “[Physicians] don't have to be the ones to do [screening] because we're just asking questions. It’s not about medicine, it's about their life, and anyone can ask questions about someone’s life.” “[Patients] should also understand that you are trying to help them, not just have a checklist in front of you. So I don't think, an environment where a medical assistant or somebody at the front door with the checklist… I don’t think it would work.” “Is [screening] happening? Yes, it’s happening. How is it happening? Sporadic.” “I don’t feel like it’s as instinctive for us to do [screening] unless it’s on our radar or there’s some specific forms or something that we have to do.” “Everybody has to go through this [screening] process.” Resources/Actions “They do have food pantries in certain areas that do service Galveston County as a whole, but it’s just the point of being able to get there, too.” “If you really wanted to do this well, each clinic has to have a [on-site resource coordinator]. It really, really does.” Patient-centered approach Teams need “to know the difference between when a patient is venting and when a referral is necessary, because sometimes a patient is just venting.” “I don’t want to offer something that they will never qualify for, they will never get, they will never receive…It’s like giving them Christmas and then taking it away.” Teamwork “Not to teach [medical students and residents] to go be social workers, but to teach them that there are resources out there so that they don’t just think life is helpless for this patient or hopeless for this patient.”
