Addressing Social Determinants of Health in a Clinic Setting: The Wellrx Pilot in Albuquerque, New Mexico

Page-Reeves J, Kaufman W, Bleecker M, Norris J, McCalmont K, Ianakieva V, Ianakieva D, Kaufman A
Source: J Am Board Fam Med
Publication Year: 2016
Patient Need Addressed: Behavioral health, Food insecurity, Homelessness/housing, Transportation
Population Focus: Low income
Intervention Type: Best practices, Staff design and care management
Study Design: Other Study Design
Type of Literature: White
link: https://www.ncbi.nlm.nih.gov/pubmed/27170801
Abstract

Although it is known that the social determinants of health have a larger influence on health outcomes than healthcare, there currently is no structured way for primary care providers to identify and address nonmedical social needs experienced by patients seen in a clinic setting. We developed and piloted WellRx, an 11-question instrument used to screen 3048 patients for social determinants in 3 family medicine clinics over a 90-day period. Results showed that 46% of patients screened positive for at least 1 area of social need, and 63% of those had multiple needs. Most of these needs were previously unknown to the clinicians. Medical assistants and community health workers then offered to connect patients with appropriate services and resources to address the identified needs. The WellRx pilot demonstrated that it is feasible for a clinic to implement such an assessment system, that the assessment can reveal important information, and that having information about patients’ social needs improves provider ease of practice. Demonstrated feasibility and favorable outcomes led to institutionalization of the WellRx process at a university teaching hospital and influenced the state department of health to require managed care organizations to have community health workers available to care for Medicaid patients.

Insights Results

Overview of article

  • Although it is known that the social determinants of health have a larger influence on health outcomes than healthcare, there currently is no structured way for primary care providers to identify and address nonmedical social needs experienced by patients seen in a clinic setting. This study developed and piloted WellRx, an 11-question instrument used to screen patients for social determinants
  • Eleven domains of greatest social need experienced by the patients served at 3 family medicine clinics were identified: food insecurity, housing, utilities, income, employment, transportation, education, substance abuse, child care, safety, and abuse. These domains were then incorporated into a pretested, 11-item questionnaire
  • An attempt was made to screen all patients, either by self-administered questionnaires distributed by front desk staff or by medical assistants (MAs) while recording vital signs

Results

  • WellRx questionnaires were completed by 3048 patients over the course of the 90-day pilot. MAs’ face-to-face-administration of the questionnaire yielded the highest percent age of patients reporting adverse social determinants. Of those surveyed, 46% (n = 1413) reported at least 1 social need. Of those reporting a social need, 63% (n = 890) indicated multiple needs. Needs most often indicated concerned utilities, income, employment, and education
  • Successes of the pilot: Patients who screened positive for unmet social needs were offered assistance in connecting with appropriate services and resources. MAs became resources to patients by handing out resource sheets to address identified social needs, resulting in a significant enhanced role for MAs. The role of MAs in identifying social problems and CHWs in intervention led providers to feel that their workloads had lightened. The feasibility of the pilot informed addition site implementations of the WellRx

Key takeaways/implications

  • The WellRx pilot revealed several relevant insights for primary care practice: 1) The screening process produced concrete data about the social needs in primary care patients’ live, which better-informs providers who plan to intervene; 2) WellRx provided an innovative vehicle for training residents and primary care physicians about engaging patients in discussions that would not normally surface during clinic visits; 3) The WellRx pilot revealed the important role CHWs can play in a primary care clinic as complements to social workers through home visits and community site visits; 4) The WellRx pilot demonstrated that it is feasible for a clinic to screen and address patients’ social needs on site, without disrupting clinic flow; 5) The success of the WellRx pilot laid the groundwork for a larger study involving a collaboration between state Medicaid managed care, the university, Molina healthcare of New Mexico, Blue Cross Blue Shield of New Mexico, and 2 federally qualified health centers: Hidalgo Medical Services and First Choice Community Healthcare
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