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Do patients want clinicians to ask about social needs and include this information in their medical record?
Steven M Albert1, Polly McCracken2, Thuy Bui2
1Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, 6116, 130 DeSoto St, Pittsburgh, USA. smalbert@pitt.edu.
Background:
Social needs screening in primary care may be valuable for addressing non-medical health-related factors, such as housing insecurity, that interfere with optimal medical care. Yet it is unclear if patients welcome such screening and how comfortable they are having this information included in electronic health records (EHR).
Objective:
To assess patient attitudes toward inclusion of social needs information in the EHR and key correlates, such as sociodemographic status, self-rated health, and trust in health care.
Design, Participants, And Main Measures:
In a cross-sectional survey of patients attending a primary care clinic for annual or employment exams, 218/560 (38%) consented and completed a web survey or personal interview between 8/20/20-8/23/21. Patients provided social needs information using the Accountable Care Communities Screening Tool. For the primary outcome, patients were asked, "Would you be comfortable having these kinds of needs included in your health record (also known as your medical record or chart)?"
Analyses:
Regression models were estimated to assess correlates of patient comfort with including social needs information in medical records.
Key Results:
The median age was 45, 68.8% were female, and 78% were white. Median income was $75,000 and 84% reported education beyond high school. 85% of patients reported they were very or somewhat comfortable with questions about social needs, including patients reporting social needs. Social need ranged from 5.5% (utilities) to 26.6% (housing), and nonwhite and gender-nonconforming patients reported greater need. 20% reported "some" or "complete" discomfort with social needs information included in the EHR. Adjusting for age, gender, race, education, trust, and self-rated health, each additional reported social need significantly increased discomfort with the EHR for documenting social needs.
Conclusions:
People with greater social needs were more wary of having this information placed in the EHR. This is a concerning finding, since one rationale for collecting social need data is to use this information (presumably in the EHR) for addressing needs.
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