RT Journal Article
SR Electronic
T1 Clinician and Staff Perspectives on a Social Drivers of Health Program Implementation
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 1103
OP 1122
DO 10.3122/jabfm.2023.230316R2
VO 37
IS 6
A1 Vilendrer, Stacie M.
A1 Thomas, Samuel C.
A1 Brunisholz, Kim
A1 Kumar, Grace Ann
A1 Singh, Ishita
A1 Song, Nancy
A1 Srivastava, Raj
A1 Singer, Sara J.
YR 2024
UL http://www.jabfm.org/content/37/6/1103.abstract
AB Introduction: Health systems are increasingly pursuing efforts to screen for and address social drivers of health (SDOH), the nonmedical factors that contribute to health outcomes and inequities. A large integrated health system (Intermountain Health) launched a program in 2019 to universally screen for and address SDOH.Methods: Five primary care clinics within Intermountain were purposefully chosen for diversity of setting and practice type (family medicine and pediatric). We conducted 20 semistructured interviews with frontline clinicians and staff from 7/1/2020 to 9/1/2020 to explore attitudes related to feasibility, workflow processes, and facilitators and barriers to successful implementation. We conducted an inductive-deductive analysis to identify key themes and best practices.Results: Five clinics conducted 16,659 SDOH patient screenings from 12/1/2019 to 11/30/2020 (705 to 7,723 screens per clinic with rates ranging from 7.4% to 52.8% per clinic). Respondent perspectives about the program were mixed. Dominant implementation barriers included staff time constraints, limited availability of social services, and reduced morale. Key facilitators included triage protocols for positive screens independent of the primary care clinician, standardizing previsit digital screening, and instilling a culture of shared ownership through education and team SDOH-focused huddles.Conclusions: This evaluation of an early systemwide SDOH program implementation called into question the feasibility of universal screening in primary care given staff time constraints and social service availability. Future investigations should explore the impact of targeted screening approaches in diverse clinical settings and quantifying trade offs between SDOH programs and other clinical and organizational priorities.