key: cord-0030689-gl0204hd
authors: Pinkerton, El A.; Vu, Milkie; Lindau, Stacy Tessler
title: Health-related socioeconomic risk screening in outpatient obstetrics and gynecology practice
date: 2022-04-02
journal: Am J Obstet Gynecol
DOI: 10.1016/j.ajog.2022.03.060
sha: d4ad1cbdc3f2d0087cc19d61cddab5b7f45b9165
doc_id: 30689
cord_uid: gl0204hd

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Health-related socioeconomic risk screening in outpatient obstetrics and gynecology practice OBJECTIVE:

The COVID-19 pandemic has exacerbated socioeconomic barriers to health among people seeking obstetrical and gynecologic care, including cisgender women and transgender patients. 1, 2 Increased socioeconomic vulnerability in these populations is associated with alarmingly high rates of mental health problems observed during the pandemic. 1, 2 The American College of Obstetricians and Gynecologists (ACOG) recommends that healthcare providers screen and refer for health-related socioeconomic risk factors (HRSRs) as a means to provide more effective care, improve individual health outcomes, and reduce population-level inequities in reproductive health. 3 Previous studies have established the appropriateness of HRSR screening among primary care patients and caregivers of pediatric patients. 4 To complement the ACOG recommendation, this study examined how obstetrical and gynecologic patients perceive HRSR screening and documentation.

A cross-sectional convenience sample of patients was recruited from urban, academic obstetrical and gynecologic clinics between April 2019 and June 2019. Eligible participants were English-or Spanish-speaking patients aged 18 years and able to provide informed consent. Potential participants were approached in clinic waiting areas, provided with information about the study, and screened for eligibility if interested. Eligible participants completed a self-administered survey assessing sociodemographic characteristics, HRSR status, and attitudes toward HRSR screening and documentation in electronic health records (EHRs). All participants provided verbal confirmation of the informed consent process. The protocol was approved by the institutional review board. Descriptive statistics were used to summarize survey responses across all patients and stratified by HRSR status (no HRSR or 1 HRSR).

Of the 133 patients who expressed interest when approached, 79 met eligibility criteria and were included in the sample. Moreover, 47% of patients reported 1 HRSR, including food insecurity (33%), housing instability (25%), transportation difficulties (22%), utilities difficulties (13%), and interpersonal violence (1%) (Table) . The desire for assistance with HRSRs was endorsed by 90% of patients with utilities difficulties (n¼9), 65% of patients with housing instability (n¼13), and 73% of patients with food insecurity (n¼19). Among all patients with 1 HRSR, 60% desired assistance with HRSRs (32% overall), 72% were comfortable with EHR documentation (66% overall), and 92% felt it was appropriate to assess for HRSRs in clinical settings (82% overall).

Consistent with the ACOG recommendations and studies of other patient populations, 4 most obstetrical and gynecologic patients felt that HRSR screening in a clinical setting was appropriate and were comfortable with EHR documentation. Most patients with HRSRs desired assistance. Although generalizability was limited by a small convenience sample and the single institution design, our findings support the US healthcare sector's investment in social care integration. The National Academies of Science, Engineering, and Medicine's social care framework 5 emphasizes the importance of not only assessing HRSRs but assisting patients to mitigate healthrelated socioeconomic vulnerability, a prevalent condition among people presenting for obstetrical and gynecologic care before and during the COVID-19 pandemic. 1,2 To enable systematic assessment and assistance, our team developed the CommunityRx intervention. CommunityRx is an evidence-based, electronic medical record-integrated, and personalized community resource referral system that connects patients to resources in their community to address health-related social risk factors and wellness, disease self-management, and caregiving needs. 6 EHR, electronic health record; HRSR, health-related socioeconomic risk factor. a Includes participants self-identifying as Asian, >1 race, or other unspecified race.

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Change in health-related socioeconomic risk factors and mental health during the early phase of the COVID-19 pandemic: a national survey of U.S. women

Characterising the impact of COVID-19 environment on mental health, gender affirming services and socioeconomic loss in a global sample of transgender and non-binary people: a structural equation modelling

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Part I: a quantitative study of social risk screening acceptability in patients and caregivers

Board on Health Care Services, Committee on Integrating Social Needs Care into the Delivery of Health Care to Improve the Nation's Health. Integrating social care into the delivery of health care: moving upstream to improve the nation's health

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Research Letter ajog.org the study; collection, analysis, or interpretation of the data; writing of the manuscript; or decision to submit the manuscript for publication.