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Implementation context for addressing social needs in a learning health system: a qualitative study.

Ryan P Theis1,2, Katherine Blackburn1,2, Gloria Lipori2,3

  • 1Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL, USA.

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Integrating social needs into electronic health records (EHRs) requires addressing patient comfort, privacy, and provider time. System support and community resource availability are crucial for successful implementation of social needs assessments.

Keywords:
electronic health recordsimplementation sciencequalitative researchsocial determinants of health

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Area of Science:

  • Health Services Research
  • Implementation Science
  • Digital Health

Background:

  • Unmet social needs exacerbate health disparities and increase healthcare costs.
  • Integrating social needs data into electronic health records (EHRs) can link patients to community resources.
  • Contextual factors influencing the implementation of such interventions in clinical settings require further investigation.

Purpose of the Study:

  • To explore patient and provider perspectives on implementing a module for collecting and integrating patient-reported social needs into EHRs.
  • To identify facilitators and barriers to the acceptability and feasibility of social needs screening in primary care.

Main Methods:

  • Qualitative interviews with 40 patients and focus groups with 12 providers across two primary care clinics.
  • Data collection focused on constructs from the Theoretical Framework for Acceptability and Consolidated Framework for Implementation Research.
  • Framework analysis involving deductive and inductive coding and matrix analyses.

Main Results:

  • Patient concerns included discomfort with sensitive questions, privacy, module readability, and technological literacy.
  • Provider rapport facilitated patient disclosure of social needs.
  • Providers identified limited patient time and lack of community resources as significant barriers.

Conclusions:

  • Flexible approaches are needed for assessing and discussing patient social needs.
  • Health system support is essential for the feasibility of social needs interventions.
  • The availability of community resources must be studied to ensure intervention effectiveness.