Assessing Alignment of Patient and Clinician Perspectives on Community Health Resources for Chronic Disease Management
Abstract
:1. Introduction
2. Methods
2.1. Study Setting and Sample
2.2. Data Collection
2.3. Qualitative Methods and Procedures
2.3.1. Patient Interviews
2.3.2. Clinician Interviews
2.3.3. Qualitative Analysis
2.4. Quantitative Methods and Procedures
2.4.1. Mapped Community Resource Data
2.4.2. Analysis
3. Results
3.1. Participant Characteristics
3.2. Qualitative Findings
3.2.1. Theme #1: Misalignment between the Prioritization of Social Needs by Clinicians and Patients
Patient Descriptions of Social Needs Resources
“…there’s a little market over here. If you want something that they don’t carry, they accommodate you and bring it in. They have some fresh fruits and vegetables a block further down. So, it’s much more convenient here for procuring food.”—Patient 3
“We have a house nurse on premises and I finally confessed to her what I was doing and that I needed help being more religious about taking the medication so she brings it down every day, she’s here five days a week, brings it down every day and I take it while she’s in the room.”—Patient 3
Clinician Descriptions of Social Needs Resources
“‘What are your needs for shelter and food?’… I think those are the priority, but I think what ends up happening is if the patient doesn’t mention it, and you’re not actively looking for it, it doesn’t always come up. Sometimes it will happen that, “I know we have this program. Let’s be on the lookout for patients who need this thing…” It’s not that you’re not screening, but it’s like you’re particularly on the lookout when there’s something to actually offer. I don’t think that’s a conscious way of prioritizing, but I think the reality is that you might be more likely to be aware of it or asking about it when there is some particular resource to be had or to be used.”—Clinician 3
“Well, the only meal resource that I know how to refer to that I personally actually know how to do is the project in San Francisco, the Project Open Hand, which is just a single form that you fill out and fax in all the information. It’s very straightforward and the eligibility criteria are on the application. The fax number is on the application. Everything is right there. So, I don’t have to think very much about it. I could just go and fill it out.”—Clinician 5
3.2.2. Theme #2: A Myriad of Clinical Workflows for Linking Patients to Social Resources
“Then I will often quickly go around to the different team members and do a mini huddle with them because I’ve missed the big group huddle, but I will say what makes it—we tend to know our patients very well… [I] know most of the people who are coming in and what their needs are… it makes the huddle actually more meaningful because we tend to know everyone.”—Clinician 2
“…they have contributed a lot in terms of the number of patients that they interact with, the proactive screening, the refining of social risk screening tools… They still contribute hugely to the resources both in [the EHR] and certainly to the one that you’ll eventually see that is a Google Doc that everybody’s been using.”—Clinician 1
“A big thing is these things are often self-limited, and they change all the time and don’t have somebody who can update them. One of the things that we’d always thought about are figuring out the exercise resources that are available for the patients with low income, and you’d think that rec and park might do that, but it’s not easy, and they’re not coordinated. We’ve had this dream of having a central resource bank or something. So, yes, it would be great to try to coordinate our efforts.”—Clinician 3
“I think something that I’ve experienced this past week a lot lately is our patients who are Hispanic or Spanish-speaking patients… healthcare is very different in their countries. When they come here and they need refills on medication, they think that they need to come to the clinic and request it. So oftentimes, they go without medication for two or three or four weeks… there’s a lot of education involved around letting patients know from the very beginning like your clinician has given you a year’s worth of medication at the pharmacy.”—Clinician 7
“I know [if they access a resource] when I check in on them, but like there is not a good system set up… the thing that’s tough is you’re exchanging information…that’s identifying healthcare systems with community-based organizations. With HIPAA [the Health Insurance Portability and Accountability Act] it’s very hard to do that in a warm hand off way. So, most of the time no. We give them the info I’d say, I give them the info, or my team does, and we hope for the best.”—Clinician 6
3.3. Quantitative Findings
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Patients (n = 10) | ||||||
---|---|---|---|---|---|---|
Patient # | Race/Ethnicity | Gender | Age Group | Income | Neighborhood | Chronic Diseases |
1 | Black/African American | Female | 60–64 | Not answered | Bayview–Hunter’s Point | Diabetes |
2 | Black/African American | Male | 60–64 | Not answered | Bayview–Hunter’s Point | Diabetes, heart disease, high blood pressure, heart failure, asthma/COPD, chronic pain in back/legs |
3 | White | Female | 65–69 | Less than USD 20,000 | Tenderloin | Pre-diabetes, heart disease, high blood pressure, asthma/COPD, depression, anxiety |
4 | Asian or Pacific Islander | Female | 60–64 | USD 20,000–40,000 | Tenderloin | Diabetes, heart disease, high blood pressure, asthma/COPD, depression, anxiety, osteoarthritis, PTSD |
5 | Black/African American | Female | 70–74 | Less than USD 20,000 | Western Addition | Diabetes, high blood pressure, neuropathy |
6 | Black/African American | Male | 55–59 | Less than USD 20,000 | Tenderloin | Diabetes, high blood pressure, depression, anxiety, cataracts |
7 | Black/African American; Multi-Ethnic | Female | 60–64 | Less than USD 20,000 | Bayview–Hunter’s Point | High blood pressure, depression, anxiety, rheumatoid arthritis, fibromyalgia, lupus |
8 | American Indian/Native American | Male | 60–64 | USD 20,000–40,000 | Excelsior | Diabetes, high blood pressure, asthma/COPD, chronic kidney disease, depression, high cholesterol, liver disease, nasal inflammation |
9 | Black/African American | Female | 55–59 | Less than USD 20,000 | Bayview–Hunter’s Point and Lakeshore | Diabetes, high blood pressure, chronic kidney disease, high cholesterol |
10 | Hispanic/Latinx | Female | 45–59 | Less than USD 20,000 | Tenderloin | Pre-diabetes, depression, anxiety |
Clinicians (n = 7) | ||||||
Clinician # | Role | Role Description | ||||
1 | Primary care physician | Family medicine physician | ||||
2 | Primary care physician | Internist at safety-net clinic | ||||
3 | Nurse practitioner | Family practice nurse practitioner at primary care center | ||||
4 | Nurse practitioner | Family nurse practitioner at community health center | ||||
5 | Primary care physician | Resident physician in family medicine program | ||||
6 | Primary care physician | Pediatrician | ||||
7 | Nurse educator | Nurse educator in a public healthcare delivery system |
Social Need | Clinician Perspective | Patient Perspective | Misalignment in Perspectives |
---|---|---|---|
Food | Clinician 2 reported that if they hear a patient is struggling to access fresh fruits and vegetables, they will refer the patient to a social worker who could arrange for the patients to receive groceries through the clinic’s food pharmacy. | Patient 7 reported that a particular location of a chain grocery store has substandard or rotten meat and vegetables. Patient 4 mentioned a farmer’s market held twice a week in their neighborhood. | While clinicians seek to connect patients with a readily available food resource, patients are concerned with the quality and proximity of food resources. |
Physical Activity Spaces | Clinician 4 described making referrals to an exercise coaching program at the hospital. | Patient 6 described visiting a local community center for tai chi classes. Patient 10 mentioned attending free yoga and holistic healing classes in their neighborhood. | While clinicians sought to connect patients with established exercise programs through the health network, patients described attending exercise classes that were located in their neighborhood and offered more options for activities. |
Transportation | Clinicians 3 and 4 discussed referring patients to the behavioral health team for resources such as transportation vouchers. | Patient 1 described using certain bus lines to visit the hospital. Patient 9 discussed the challenges of obtaining an electric wheelchair in order to utilize transportation. | While clinicians sought to provide financial support for transportation, patients expressed concern about the usability of transportation options, beyond affordability. |
Resource Lists | Clinician 5 described creating a resource list on Google Docs based on suggestions from fellow clinicians and outreach from CBOs for clinicians to reference. | Patient 5 identified 211 * as a social services resource list available via phone. | While clinicians sought to compile internal lists to be shared with patients on an individual basis, patients described publicly available resource lists. Moreover, patients expressed the importance of word-of-mouth referrals through informal social networks for increasing resource awareness. |
Pharmacy Access | Clinician 6 discussed making referrals to certain pharmacies based on what insurance plans they accepted. | Patient 2 reported a preference for a specific pharmacy that organized and packaged pills in a convenient manner. | While clinicians sought to prioritize affordability and accessibility of pharmacy-dispensed medication, patients expressed additional interest in convenient and usable medication packaging. |
Community Cohesion | Clinician 2 described the activities led by the Wellness Center at the hospital to foster community togetherness. | Patient 7 discussed experiencing community cohesiveness through an informal “buddy system” to ensure safety for all the seniors in their neighborhood complex. | While clinicians described health network-based opportunities for community development, patients pointed out informal and local resources for improving community cohesion. |
Category | # of Resources in Community-Generated Data (Percentage) * | # of Resources in Health System-Maintained Data (Percentage) |
---|---|---|
Food | 43 (22.51%) | 27 (5.96%) |
Health | 38 (19.89%) | 64 (14.12%) |
Education | 13 (6.80%) | 27 (5.96%) |
Transportation | 12 (6.28%) | 5 (1.10%) |
Housing | 8 (4.19%) | 47 (10.37%) |
Social Services | 30 (15.70%) | 138 (30.46%) |
Art | 9 (4.71%) | 3 (0.66%) |
Other (Substance Use Disorder Services, Legal Services, or Environment/Public Spaces) | 38 (19.89%) | 86 (18.98%) |
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Potharaju, K.A.; Fields, J.D.; Cemballi, A.G.; Pantell, M.S.; Desai, R.; Akom, A.; Shah, A.; Cruz, T.; Nguyen, K.H.; Lyles, C.R. Assessing Alignment of Patient and Clinician Perspectives on Community Health Resources for Chronic Disease Management. Healthcare 2022, 10, 2006. https://doi.org/10.3390/healthcare10102006
Potharaju KA, Fields JD, Cemballi AG, Pantell MS, Desai R, Akom A, Shah A, Cruz T, Nguyen KH, Lyles CR. Assessing Alignment of Patient and Clinician Perspectives on Community Health Resources for Chronic Disease Management. Healthcare. 2022; 10(10):2006. https://doi.org/10.3390/healthcare10102006
Chicago/Turabian StylePotharaju, Kameswari A., Jessica D. Fields, Anupama G. Cemballi, Matthew S. Pantell, Riya Desai, Antwi Akom, Aekta Shah, Tessa Cruz, Kim H. Nguyen, and Courtney R. Lyles. 2022. "Assessing Alignment of Patient and Clinician Perspectives on Community Health Resources for Chronic Disease Management" Healthcare 10, no. 10: 2006. https://doi.org/10.3390/healthcare10102006