Study Themes with Supporting Data
| Theme | Representative quotes | Supporting survey data |
|---|---|---|
| Theme 1. Clinicians reported making frequent adjustments to patient care plans based on their awareness of patients’ social contexts, though concerns about adjustment were raised | ||
| Subtheme | ||
| Examples of social care adjustments acknowledged in interviews focused primarily on medication prescribing†† | How often do you change medical plans based on social needs? 1 = Never, 10 = Always: (n = 89*) | |
| Adjusting medication by cost | “I have to make sure that everything that I ever prescribed to them, is going to either be on the $4 list, or it's going to be very, very cheap, or have to do a separate coupon or something for them so they're able to actually fill it. I think, and then obviously, the amount of tests that I can order, or the amount of work up I can do, or if the patient needs a specialist, that's where my hands get really tied, because then I just don't know what to do, because we don't have specialists at the clinic. It gives me a heads up to what I'm walking into, and how I have to change stuff around for the patient…” | Mean 7.4/10, 95% Confidence interval (CI)† 6.9, 7.9 |
| Adjusting medication by side effects/monitoring parameters | “Hypertension and diabetes is [sic] the biggest example. …it really does impact how I practice. In hypertension, people that aren't housed I try to give a lot of amlodipine because I don't have to monitor and dehydration usually won't affect them …And then with diabetes, where insulin can be stored, if someone's insulin dependent, and which types of insulin I'm giving are affected by, if they have a fridge, access to a fridge or not.” | |
| Adjusting the pharmacy used | “if there is even a speck of anything on the [social risk] questionnaire then I know that I have to change the patient's pharmacy …to [a] cheaper pharmacy.” | |
| Adjusting diagnostic work-up | “Some patients say, ‘I can't. I'm not going to do it because I can't afford it,’ so I do adjust for that. For example, if there's a patient that has postmenopausal bleeding, yes ideally we do have an ultrasound, but if they really cannot do the ultrasound at least I'm going to do the endometrium biopsy and go from that because they're already telling me they cannot do it.” | |
| Adjusting follow-up care plans | “There's a couple patients like this, but people who really don't have access to transportation to get to the clinic or they're very dependent on their family for financial means, for example, even just to get medications and stuff like that, adults. So I think when I know that that's an issue, I again, try to just anticipate what they need and maybe even potentially at some visits, do a little bit more at one time, because I know that maybe they won't be able to get to the next visit” | |
| Concerns around providing lower quality care. | “I don't know if I would be more comfortable with changing a treatment plan … because I cannot offer you information on how you can save your tooth because I'm assuming that you can't afford it. …if I'm ready to alter my treatment plan and just only present extractions, really it's unethical because if this person can find a way to save their tooth, they should save their tooth if they want to. So I don't know about altering the treatment plan. Maybe it would be better for me when I'm discussing the treatment plan or my assistant is discussing the treatment plan to say, “These are the options. But we understand that this may not be an option for you.” | There are many factors that might influence how and when providers use social information to inform clinical decision making. How important is each of the factors below? (1 = Not important; 10 = Very important): I am concerned that I am not giving my patients the best care: (n = 88) Mean 7.1, 95% CI 6.5 to 7.6 I am concerned that my patients might feel uncomfortable or as if they’re not getting the best care: (n = 88) Mean 6.1, 95% CI 5.5 to 6.7 I am concerned that changing medical decision making based on social/economic needs is unethical: (n = 85) Mean 5.8, 95% CI 5.2 to 6.4 |
| Role of shared decision-making | “I try to include the patients as part of the medical decision-making and see what they can or cannot [do], because I don't like to just order a test and assume the patient is going to go and do it or order a treatment and assume they're going to go and buy it. I guess I just try to get feedback to see if that makes sense.” | - |
| Theme 2. Awareness of patients’ social risk factors, and clinician time, training, and experience all facilitated clinician adjustments | ||
| Importance of social risk factor awareness, time, training or experience | “[Social risk screening] gives me a heads up to what I'm walking into, and how I have [to] change stuff around for the patient… it's not just me sending the prescription to the pharmacy electronically, the patient needs to fill it, and take it, as well.” | There are many factors that might influence how and when providers use social information to inform clinical decision making. How important is each of the factors below? (1 = Not important; 10 = Very important): I am aware of patients’ social/economic needs at the point of care: (n = 88) Mean 8.3, 95% CI 7.8-8.7 I have enough time to consider social needs when making treatment plans: (n = 87) Mean 7.8, 95% CI 7.3 to 8.3 I have enough training or experience to change medical care based on patients’ social/economic needs: (n = 88) Mean 7.8, 95% CI 7.3 to 8.2 |
↵* Participants could skip any question; total number of respondents can vary by question.
↵† For each survey question, the confidence interval represents the mean response value for all survey respondents.
↵†† Examples reproduced, with permission, De Marchis EH, Aceves BA, Razon N, Chang Weir R, Jester M, Gottlieb LM. Lessons from Texas: Social care activities in four community health centers. 2022. San Francisco, CA: Social Interventions Research and Evaluation Network. Available at: Available at: https://sirenetwork.ucsf.edu/tools-resources/resources/lessons-texas-social-care-activities-four-community-health-centers. (Accessed August 1, 2023).
¶ Same question stem used.