Elena M. Marks, “Screening Patients for Non-Medical Needs Is Valuable Even When Clinicians Can’t Resolve Identified Needs” (Houston: Rice University’s Baker Institute for Public Policy, June 21, 2024), https://doi.org/10.25613/VRYK-PG90.
During a recent medical appointment, you may have been asked a series of questions about your access to food, housing, or transportation. These questions stem from a growing recognition of the significant impact non-medical factors have on health and the crucial role medical providers can play in addressing these needs. Regulatory, financing, and standard-setting organizations like the Centers for Medicare and Medicaid Services are increasingly requiring medical care providers to screen patients for non-medical needs in an effort to improve health outcomes. Some providers are assisting patients in accessing non-medical services based on these screenings. However, there is debate over the effectiveness of this practice when resources are not provided following the screenings.
Research indicates that there are benefits for both patients and providers from screening for non-medical needs. This commentary offers a high-level overview of research on this topic. The Social Integration Research and Evaluation Network at the University of California, San Francisco, maintains a searchable resource hub with dozens of studies on this topic. An excellent summary, as of 2022, can be found in their publication, “State of the Science on Social Screening in Healthcare Settings.”
As screening for non-medical needs has increased over the last decade, researchers have started investigating patient perspectives on this practice. Findings indicate that adult patients and caregivers of pediatric patients generally view these screenings as appropriate. For example, a multisite study by Emilia H. De Marchis et al. found that 79% of participants believe screenings in emergency rooms and primary care settings are very or somewhat appropriate. In other studies, 86% of dermatology patients reported that screenings were very or somewhat appropriate, as did 65% of caregivers of pediatric liver transplant patients.
Researchers also learned that patients felt emotionally supported when screened for non-medical needs, perceiving these actions as an expression of provider empathy for their overall health and well-being. In a study involving a provider-based navigation program, caregivers of pediatric patients in an urgent care setting reported that they felt emotionally supported and experienced reduced isolation and anxiety. In the multisite study cited above, interviewees expressed feelings of relief or gratitude after the screening and described feeling “cared for” and “listened to.” Many patients also reported these positive sentiments regardless of whether the provider could address their non-medical problems, and some did not expect or want assistance with these issues from medical providers.
Medical professionals and medical ethicists have debated the appropriateness and value of asking patients about their non-medical circumstances when providers cannot address those needs. However, research indicates that understanding patients’ life circumstances can benefit providers as well.
A 2019 study by Charles Senteio et al. examined whether and how clinicians value and use patients’ psychosocial information. Physicians reported using this non-medical information to make informed decisions regarding target levels of control for diabetic patients, medication management, patient recommendations, and referrals. For example, a patient’s lack of access to a refrigerator can change a physician’s prescribing patterns, as can other home circumstances such as transportation issues and family responsibilities.
A review of 73 studies by De Marchis et al., published by the Social Intervention Research and Evaluation Network (SIREN), found that screening for social risks generally enhanced the patient-provider relationship or had no negative impact. Respecting patients’ privacy and showing empathy during the screening process is key to building and improving these relationships.
As efforts to control health care costs and improve health outcomes continue across the United States, we can expect to see an increase in the screening for and addressing of non-medical factors of health. The Texas Legislature took an important step in the 2023 session by passing House Bill 1575, which requires that pregnant women in the Medicaid program be screened for non-medical needs and receive care management services to address these needs. This new practice is expected to improve maternal health outcomes.
Over time, we hope to see this approach expanded to other populations as state and federal governments and health care accrediting bodies implement more comprehensive screening requirements. By improving how medical providers understand and address patients’ non-medical needs, our health care system can foster more equitable and effective care for all.
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