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Associations Between Social Risks and Primary Care Utilization Among Medically Complex Veterans.

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Social risks like unemployment were linked to less primary care use in complex patients. Social work was underutilized, indicating a need to improve access to these vital services for vulnerable populations.

Keywords:
primary caresocial determinants of healthsocial work

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Area of Science:

  • Health Services Research
  • Social Determinants of Health
  • Primary Care Medicine

Background:

  • Social risks significantly impact health outcomes, particularly for individuals with complex medical conditions.
  • These social risks may also present barriers to accessing essential primary care services.

Purpose of the Study:

  • To investigate the relationship between various social risks and the utilization of primary care services among patients with medical complexity.
  • To identify specific social factors influencing primary care engagement in a high-risk veteran population.

Main Methods:

  • A prospective cohort study was conducted using a nationally representative sample of 10,000 Veterans Affairs (VA) primary care patients at high risk for hospitalization or death.
  • Data were collected via a 2018 mailed survey assessing social risks (e.g., unemployment, low medical literacy, low social support) and linked to electronic health records for utilization outcomes over 2 years.
  • Outcomes included primary care provider (PCP) encounters, primary care team encounters, and social work utilization.

Main Results:

  • Among 4680 respondents, unemployment correlated with fewer PCP and primary care team encounters.
  • Low medical literacy was associated with increased primary care team encounters.
  • Social work encounters were low overall (18.4%), but higher odds were linked to low medical literacy, transportation problems, and low social support.

Conclusions:

  • Primary care and primary care team utilization showed minimal differences based on social risk among medically complex VA patients.
  • Despite its importance in addressing social risks, social work service utilization was notably low.
  • Further research is required to elucidate the barriers preventing greater social work engagement among this population.