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

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Abstract

Background

Social risks contribute to poor health outcomes, especially for patients with complex medical needs. These same risks may impact access to primary care services.

Objective

To study associations between social risks and primary care utilization among patients with medical complexity.

Design

Prospective cohort study of respondents to a 2018 mailed survey, followed up to 2 years after survey completion.

Participants

Nationally representative sample of 10,000 primary care patients in the Veterans Affairs (VA) health care system, with high (≥ 75th percentile) 1-year risk of hospitalization or death.

Main Measures

Survey-based exposures were low social support, no family member/friend involved in health care, unemployment, transportation problem, food insecurity, medication insecurity, financial strain, low medical literacy, and less than high school graduate. Electronic health record–based outcomes were number of primary care provider (PCP) encounters, number of primary care team encounters (PCP, nurse, clinical pharmacist, and social worker), and having ≥ 1 social work encounter.

Key Results

Among 4680 respondents, mean age was 70.3, 93.7% were male, 71.8% White non-Hispanic, and 15.8% Black non-Hispanic. Unemployment was associated with fewer PCP and primary care team encounters (incident rate ratio 0.77, 95% CI 0.65–0.91; p = 0.002 and 0.75, 0.59–0.95; p = 0.02, respectively), and low medical literacy was associated with more primary care team encounters (1.17, 1.05–1.32; p = 0.006). Among those with one or more social risks, 18.4% had ≥ 1 social work encounter. Low medical literacy (OR 1.95, 95% CI 1.45–2.61; p < 0.001), transportation problem (1.42, 1.10–1.83; p = 0.007), and low social support (1.31, 1.06–1.63; p = 0.01) were associated with higher odds of  ≥ 1 social work encounter.

Conclusions

We found few differences in PCP and primary care team utilization among medically complex VA patients by social risk. However, social work use was low, despite its central role in addressing social risks. More work is needed to understand barriers to social work utilization.

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References

  1. Davidson KW, Krist AH, Tseng CW, et al. Incorporation of Social Risk in US Preventive Services Task Force Recommendations and Identification of Key Challenges for Primary Care. JAMA. 2021;326(14):1410-1415. doi:https://doi.org/10.1001/jama.2021.12833.

    Article  PubMed  Google Scholar 

  2. Braveman P, Gottlieb L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Rep Wash DC 1974. 2014;129 Suppl 2(Suppl 2):19-31. doi:https://doi.org/10.1177/00333549141291S206.

    Article  Google Scholar 

  3. Knighton AJ, Stephenson B, Savitz LA. Measuring the Effect of Social Determinants on Patient Outcomes: A Systematic Literature Review. J Health Care Poor Underserved. 2018;29(1):81-106. doi:https://doi.org/10.1353/hpu.2018.0009.

    Article  PubMed  Google Scholar 

  4. Krause TM, Schaefer C, Highfield L. The association of social determinants of health with health outcomes. Am J Manag Care. 2021;27(3):e89-e96. doi:https://doi.org/10.37765/ajmc.2021.88603.

    Article  PubMed  Google Scholar 

  5. von dem Knesebeck O, Bickel H, Fuchs A, et al. Social inequalities in patient-reported outcomes among older multimorbid patients--results of the MultiCare cohort study. Int J Equity Health. 2015;14:17. doi:https://doi.org/10.1186/s12939-015-0142-6.

    Article  Google Scholar 

  6. Coughlin SS, Datta B, Berman A, Hatzigeorgiou C. A cross-sectional study of financial distress in persons with multimorbidity. Prev Med Rep. 2021;23:101464. doi:https://doi.org/10.1016/j.pmedr.2021.101464.

    Article  PubMed Central  PubMed  Google Scholar 

  7. McGilton KS, Vellani S, Yeung L, et al. Identifying and understanding the health and social care needs of older adults with multiple chronic conditions and their caregivers: a scoping review. BMC Geriatr. 2018;18(1):231. doi:https://doi.org/10.1186/s12877-018-0925-x.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Daniel H, Bornstein SS, Kane GC, et al. Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper. Ann Intern Med. 2018;168(8):577-578. doi:https://doi.org/10.7326/M17-2441.

    Article  PubMed  Google Scholar 

  9. Havranek EP, Mujahid MS, Barr DA, et al. Social Determinants of Risk and Outcomes for Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2015;132(9):873-898. doi:https://doi.org/10.1161/CIR.0000000000000228.

    Article  PubMed  Google Scholar 

  10. Byhoff E, Kangovi S, Berkowitz SA, et al. A Society of General Internal Medicine Position Statement on the Internists’ Role in Social Determinants of Health. J Gen Intern Med. 2020;35(9):2721-2727. doi:https://doi.org/10.1007/s11606-020-05934-8.

    Article  PubMed Central  PubMed  Google Scholar 

  11. National Academies of Sciences, Engineering, and Medicine. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health. The National Academies Press; 2019.

    Google Scholar 

  12. Institute of Medicine. Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2. The National Academies Press; 2014. https://doi.org/10.17226/18951.

  13. Houlihan J, Leffler S. Assessing and Addressing Social Determinants of Health: A Key Competency for Succeeding in Value-Based Care. Prim Care. 2019;46(4):561-574. doi:https://doi.org/10.1016/j.pop.2019.07.013.

    Article  PubMed  Google Scholar 

  14. Castrucci BC, Auerbach J. Meeting Individual Social Needs Falls Short Of Addressing Social Determinants Of Health. Health Affairs Forefront. Published January 16, 2019. Accessed 29 May 2022. https://www.healthaffairs.org/do/10.1377/forefront.20190115.234942//.

  15. Gurewich D, Garg A, Kressin NR. Addressing Social Determinants of Health Within Healthcare Delivery Systems: a Framework to Ground and Inform Health Outcomes. J Gen Intern Med. 2020;35(5):1571-1575. doi:https://doi.org/10.1007/s11606-020-05720-6.

    Article  PubMed Central  PubMed  Google Scholar 

  16. LaForge K, Gold R, Cottrell E, et al. How 6 Organizations Developed Tools and Processes for Social Determinants of Health Screening in Primary Care: An Overview. J Ambulatory Care Manage. 2018;41(1):2-14. doi:https://doi.org/10.1097/JAC.0000000000000221.

    Article  PubMed  Google Scholar 

  17. Alley DE, Asomugha CN, Conway PH, Sanghavi DM. Accountable Health Communities--Addressing Social Needs through Medicare and Medicaid. N Engl J Med. 2016;374(1):8-11. doi:https://doi.org/10.1056/NEJMp1512532.

    Article  CAS  PubMed  Google Scholar 

  18. Fraze TK, Brewster AL, Lewis VA, Beidler LB, Murray GF, Colla CH. Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals. JAMA Netw Open. 2019;2(9):e1911514. doi:https://doi.org/10.1001/jamanetworkopen.2019.11514.

    Article  PubMed Central  PubMed  Google Scholar 

  19. American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association. Joint Principles of the Patient-Centered Medical Home.; 2007. Accessed 29 May 2022. https://www.aafp.org/dam/AAFP/documents/practice_management/pcmh/initiatives/PCMHJoint.pdf.

  20. Garg A, Jack B, Zuckerman B. Addressing the social determinants of health within the patient-centered medical home: lessons from pediatrics. JAMA. 2013;309(19):2001-2002. doi:https://doi.org/10.1001/jama.2013.1471.

    Article  CAS  PubMed  Google Scholar 

  21. Kullgren JT, McLaughlin CG, Mitra N, Armstrong K. Nonfinancial barriers and access to care for U.S. adults. Health Serv Res. 2012;47(1 Pt 2):462-485. doi:https://doi.org/10.1111/j.1475-6773.2011.01308.x.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Butkus R, Rapp K, Cooney TG, Engel LS. Envisioning a Better U.S. Health Care System for All: Reducing Barriers to Care and Addressing Social Determinants of Health. Ann Intern Med. 2020;172(2 Suppl):S50-S59. doi:https://doi.org/10.7326/M19-2410.

    Article  PubMed  Google Scholar 

  23. Deb S, Miller NA. Relations among race/ethnicity, gender, and mental health status in primary care use. Psychiatr Rehabil J. 2017;40(2):233-243. doi:https://doi.org/10.1037/prj0000230.

    Article  PubMed  Google Scholar 

  24. Donald M, Ware RS, Ozolins IZ, Begum N, Crowther R, Bain C. The role of patient activation in frequent attendance at primary care: a population-based study of people with chronic disease. Patient Educ Couns. 2011;83(2):217-221. doi:https://doi.org/10.1016/j.pec.2010.05.031.

    Article  PubMed  Google Scholar 

  25. Hooker SA, Stadem P, Sherman MD, Ricco J. Patient loneliness in an urban, underserved family medicine residency clinic: prevalence and relationship to health care utilization. Fam Pract. Published online July 7, 2020. doi:https://doi.org/10.1093/fampra/cmaa065.

  26. Taylor YJ, Spencer MD, Mahabaleshwarkar R, Ludden T. Racial/ethnic differences in healthcare use among patients with uncontrolled and controlled diabetes. Ethn Health. 2019;24(3):245-256. doi:https://doi.org/10.1080/13557858.2017.1315372.

    Article  PubMed  Google Scholar 

  27. Chwastiak LA, Rosenheck RA, Kazis LE. Utilization of primary care by veterans with psychiatric illness in the National Department of Veterans Affairs Health Care System. J Gen Intern Med. 2008;23(11):1835-1840. doi:https://doi.org/10.1007/s11606-008-0786-7.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Cunningham A, Mautner D, Ku B, Scott K, LaNoue M. Frequent emergency department visitors are frequent primary care visitors and report unmet primary care needs. J Eval Clin Pract. 2017;23(3):567-573. doi:https://doi.org/10.1111/jep.12672.

    Article  PubMed  Google Scholar 

  29. Folsom DP, McKibbin C, Jeste DV, Patterson T. Use of Primary Care and by Middle Aged and Older Persons with Schizophrenia. Prim Care Community Psychiatry. 2006;11(3):101-106. doi:https://doi.org/10.1185/135525706X121174.

    Article  Google Scholar 

  30. Ford JD, Trestman RL, Steinberg K, Tennen H, Allen S. Prospective association of anxiety, depressive, and addictive disorders with high utilization of primary, specialty and emergency medical care. Soc Sci Med 1982. 2004;58(11):2145-2148. doi:https://doi.org/10.1016/j.socscimed.2003.08.017.

    Article  Google Scholar 

  31. Fortney JC, Maciejewski ML, Warren JJ, Burgess JF. Does improving geographic access to VA primary care services impact patients’ patterns of utilization and costs? Inq J Med Care Organ Provis Financ. 2005;42(1):29-42. doi:https://doi.org/10.5034/inquiryjrnl_42.1.29.

    Article  Google Scholar 

  32. Riley ED, Wu AW, Junge B, Marx M, Strathdee SA, Vlahov D. Health services utilization by injection drug users participating in a needle exchange program. Am J Drug Alcohol Abuse. 2002;28(3):497-511. doi:https://doi.org/10.1081/ada-120006738.

    Article  PubMed  Google Scholar 

  33. Wong ST, Peterson S, Black C. Patient activation in primary healthcare: a comparison between healthier individuals and those with a chronic illness. Med Care. 2011;49(5):469-479. doi:https://doi.org/10.1097/MLR.0b013e31820bf970.

    Article  PubMed  Google Scholar 

  34. Banerjee S, Radak T, Khubchandani J, Dunn P. Food Insecurity and Mortality in American Adults: Results From the NHANES-Linked Mortality Study. Health Promot Pract. 2021;22(2):204-214. doi:https://doi.org/10.1177/1524839920945927.

    Article  PubMed  Google Scholar 

  35. Tan J, Wang Y. Social Integration, Social Support, and All-Cause, Cardiovascular Disease and Cause-Specific Mortality: A Prospective Cohort Study. Int J Environ Res Public Health. 2019;16(9). doi:https://doi.org/10.3390/ijerph16091498.

  36. Canterberry M, Figueroa JF, Long CL, et al. Association Between Self-reported Health-Related Social Needs and Acute Care Utilization Among Older Adults Enrolled in Medicare Advantage. JAMA Health Forum. 2022;3(7):e221874. doi:https://doi.org/10.1001/jamahealthforum.2022.1874.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Zulman DM, Maciejewski ML, Grubber JM, et al. Patient-Reported Social and Behavioral Determinants of Health and Estimated Risk of Hospitalization in High-Risk Veterans Affairs Patients. JAMA Netw Open. 2020;3(10):e2021457. doi:https://doi.org/10.1001/jamanetworkopen.2020.21457.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Wang L, Porter B, Maynard C, et al. Predicting risk of hospitalization or death among patients receiving primary care in the Veterans Health Administration. Med Care. 2013;51(4):368-373. doi:https://doi.org/10.1097/MLR.0b013e31827da95a.

    Article  PubMed  Google Scholar 

  39. Greene L, Maciejewski ML, Grubber J, Smith VA, Blalock DV, Zulman DM. Association between patient-reported social, behavioral, and health factors and emergency department visits in high-risk VA patients. Health Serv Res. 2023;58(2):383-391. doi:https://doi.org/10.1111/1475-6773.14094.

    Article  PubMed  Google Scholar 

  40. Bigdeli M, Jacobs B, Tomson G, et al. Access to medicines from a health system perspective. Health Policy Plan. 2013;28(7):692-704. doi:https://doi.org/10.1093/heapol/czs108.

    Article  PubMed  Google Scholar 

  41. Rosland AM, Nelson K, Sun H, et al. The patient-centered medical home in the Veterans Health Administration. Am J Manag Care. 2013;19(7):e263-272.

    PubMed  Google Scholar 

  42. Department of Veterans Affairs, Veterans Health Administration. Integrated Case Management Standards of Practice. Veterans Health Administration; 2019. Accessed 30 May 2022. https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8489.

  43. Beder J, Postiglione P. Social work in the Veterans Health Administration (VA) System: rewards, challenges, roles and interventions. Soc Work Health Care. 2013;52(5):421-433. doi:https://doi.org/10.1080/00981389.2012.737906.

    Article  PubMed  Google Scholar 

  44. US Department of Veterans Affairs Information Resource Center. VIReC Research User Guide: PSSG Geocoded Enrollee Files, 2015 Edition. US Department of Veterans Affairs, Health Services Research & Development Service, Information Resource Center; 2016.

  45. U.S. Department of Veterans Affairs. Enrollment Priority Groups. Accessed 30 May 2022. https://www.va.gov/healthbenefits/resources/publications/IB10-441_enrollment_priority_groups.pdf.

  46. US Department of Veterans Affairs Managerial Cost Accounting Office. Program Documents – FY21 Active Stop Codes. Accessed 30 May 2022. http://vaww.dss.med.va.gov/programdocs/pd_oident.asp.

  47. Elixhauser A, Steiner C, Palmer L. Clinical Classifications Software (CCS). Published online 2015. Accessed November 2, 2021. U.S. Agency for Healthcare Research and Quality.

  48. Yoon J, Chee CP, Su P, Almenoff P, Zulman DM, Wagner TH. Persistence of High Health Care Costs among VA Patients. Health Serv Res. 2018;53(5):3898-3916. doi:https://doi.org/10.1111/1475-6773.12989.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Frayne S, Phibbs C, Saechao F, et al. Sourcebook: Women Veterans in the Veterans Health Administration. Volume 4: Longitudinal Trends in Sociodemographics, Utilization, Health Profile, and Geographic Distribution. Women’s Health Evaluation Initiative, Women’s Health Services, Veterans Health Administration, Department of Veterans Affairs; 2018. Accessed 4 Jan 2023. https://www.womenshealth.va.gov/WOMENSHEALTH/docs/WHS_Sourcebook_Vol-IV_508c.pdf.

  50. Phillips SP. Defining and measuring gender: a social determinant of health whose time has come. Int J Equity Health. 2005;4:11. doi:https://doi.org/10.1186/1475-9276-4-11.

    Article  PubMed Central  PubMed  Google Scholar 

  51. Lett E, Asabor E, Beltrán S, Cannon AM, Arah OA. Conceptualizing, Contextualizing, and Operationalizing Race in Quantitative Health Sciences Research. Ann Fam Med. 2022;20(2):157-163. doi:https://doi.org/10.1370/afm.2792.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Dordunoo D, Abernethy P, Kayuni J, McConkey S, Aviles-G ML. Dismantling “Race” in Health Research. Can J Nurs Res Rev Can Rech En Sci Infirm. Published online January 21, 2022:8445621221074849. doi:https://doi.org/10.1177/08445621221074849.

  53. Dieleman JL, Chen C, Crosby SW, et al. US Health Care Spending by Race and Ethnicity, 2002-2016. JAMA. 2021;326(7):649-659. doi:https://doi.org/10.1001/jama.2021.9937.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Manuel JI. Racial/Ethnic and Gender Disparities in Health Care Use and Access. Health Serv Res. 2018;53(3):1407-1429. doi:https://doi.org/10.1111/1475-6773.12705.

    Article  PubMed  Google Scholar 

  55. Hayes SL, Salzberg CA, McCarthy D, et al. High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care? The Commonwealth Fund. 2016; pub 1897 vol 26. Accessed 5 Jan 2023. https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_issue_brief_2016_aug_1897_hayes_who_are_high_need_high_cost_patients_v2.pdf

  56. The American Association for Public Opinion Research. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. 9th Edition.; 2016. Accessed 30 May 2022. https://www.aapor.org/aapor_main/media/publications/standard-definitions20169theditionfinal.pdf.

  57. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573-577. doi:https://doi.org/10.7326/0003-4819-147-8-200710160-00010.

    Article  Google Scholar 

  58. Berkowitz SA, Seligman HK, Meigs JB, Basu S. Food insecurity, healthcare utilization, and high cost: a longitudinal cohort study. Am J Manag Care. 2018;24(9):399-404.

    PubMed Central  PubMed  Google Scholar 

  59. Berkowitz SA, Basu S, Meigs JB, Seligman HK. Food Insecurity and Health Care Expenditures in the United States, 2011-2013. Health Serv Res. 2018;53(3):1600-1620. doi:https://doi.org/10.1111/1475-6773.12730.

    Article  PubMed  Google Scholar 

  60. Armstrong B, Levesque O, Perlin JB, Rick C, Schectman G. Reinventing Veterans Health Administration: focus on primary care. J Healthc Manag Am Coll Healthc Exec. 2005;50(6):399-408; discussion 409.

    Google Scholar 

  61. Schall MW, Duffy T, Krishnamurthy A, et al. Improving patient access to the Veterans Health Administration’s primary care and specialty clinics. Jt Comm J Qual Saf. 2004;30(8):415-423. doi:https://doi.org/10.1016/s1549-3741(04)30047-x.

    Article  PubMed  Google Scholar 

  62. Leung LB, Rubenstein LV, Yoon J, et al. Veterans Health Administration Investments In Primary Care And Mental Health Integration Improved Care Access. Health Aff Proj Hope. 2019;38(8):1281-1288. doi:https://doi.org/10.1377/hlthaff.2019.00270.

    Article  Google Scholar 

  63. Edes T, Kinosian B, Vuckovic NH, Nichols LO, Becker MM, Hossain M. Better access, quality, and cost for clinically complex veterans with home-based primary care. J Am Geriatr Soc. 2014;62(10):1954-1961. doi:https://doi.org/10.1111/jgs.13030.

    Article  PubMed  Google Scholar 

  64. Darkins A, Ryan P, Kobb R, et al. Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemed J E-Health Off J Am Telemed Assoc. 2008;14(10):1118-1126. doi:https://doi.org/10.1089/tmj.2008.0021.

    Article  Google Scholar 

  65. U.S. Department of Veterans Affairs. Past rates: 2020 VA health care copay rates. Published October 12, 2022. Accessed 26 Apr 2023. https://www.va.gov/health-care/copay-rates/past-rates-2020/.

  66. Blosnich JR, Dichter ME, Gurewich D, et al. Health Services Research and Social Determinants of Health in the Nation’s Largest Integrated Health Care System: Steps and Leaps in the Veterans Health Administration. Mil Med. 2020;185(9-10):e1353-e1356. doi:https://doi.org/10.1093/milmed/usaa067.

    Article  PubMed  Google Scholar 

  67. Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health. 2013;38(5):976-993. doi:https://doi.org/10.1007/s10900-013-9681-1.

    Article  PubMed Central  PubMed  Google Scholar 

  68. Janio EA, Sorkin DH. Food insecurity and healthcare access, utilization, and quality among middle and later life adults in California. J Aging Health. 2021;33(3-4):171-186. doi:https://doi.org/10.1177/0898264320967563.

    Article  PubMed  Google Scholar 

  69. Fiori KP, Heller CG, Rehm CD, et al. Unmet Social Needs and No-Show Visits in Primary Care in a US Northeastern Urban Health System, 2018-2019. Am J Public Health. 2020;110(S2):S242-S250. doi:https://doi.org/10.2105/AJPH.2020.305717.

    Article  PubMed Central  PubMed  Google Scholar 

  70. Chang ET, Zulman DM, Nelson KM, et al. Use of General Primary Care, Specialized Primary Care, and Other Veterans Affairs Services Among High-Risk Veterans. JAMA Netw Open. 2020;3(6). doi:https://doi.org/10.1001/jamanetworkopen.2020.8120.

  71. Albright DL, Thyer BA, Waller RJ. Utilization of Outpatient Social Work Services Among Veterans with Combat-Related Polytrauma: A Review and Case Analysis. Mil Behav Health. 2019;7(1):4-13.

    Article  Google Scholar 

  72. Huded JM, Lee A, Song S, et al. Association of a geriatric emergency department program with healthcare outcomes among veterans. J Am Geriatr Soc JAGS. 2022;70(2):601-608.

    Article  Google Scholar 

  73. Brignone E, Gundlapalli AV, Blais RK, et al. Increased Health Care Utilization and Costs Among Veterans With a Positive Screen for Military Sexual Trauma. Med Care. 2017;55 Suppl 9 Suppl 2(9):S70-S77.

    Article  PubMed  Google Scholar 

  74. Berrett-Abebe J, Donelan K, Berkman B, Auerbach D, Maramaldi P. Physician and nurse practitioner perceptions of social worker and community health worker roles in primary care practices caring for frail elders: Insights for social work. Soc Work Health Care. 2020;59(1):46-60. doi:https://doi.org/10.1080/00981389.2019.1695703.

    Article  PubMed  Google Scholar 

  75. Hamity C, Jackson A, Peralta L, Bellows J. Perceptions and Experience of Patients, Staff, and Clinicians with Social Needs Assessment. Perm J. 2018;22:18-105. doi:https://doi.org/10.7812/TPP/18-105.

    Article  PubMed Central  PubMed  Google Scholar 

  76. Kostelanetz S, Pettapiece-Phillips M, Weems J, et al. Health Care Professionals’ Perspectives on Universal Screening of Social Determinants of Health: A Mixed-Methods Study. Popul Health Manag. Published online October 25, 2021. doi:https://doi.org/10.1089/pop.2021.0176.

  77. Cornell PY, Halladay CW, Ader J, et al. Embedding Social Workers In Veterans Health Administration Primary Care Teams Reduces Emergency Department Visits. Health Aff Proj Hope. 2020;39(4):603-612. doi:https://doi.org/10.1377/hlthaff.2019.01589.

    Article  Google Scholar 

  78. Fraser MW, Lombardi BM, Wu S, de Saxe Zerden L, Richman EL, Fraher EP. Integrated Primary Care and Social Work: A Systematic Review. J Soc Soc Work Res. 2018;9(2):175-215.

    Article  Google Scholar 

  79. McGregor J, Mercer SW, Harris FM. Health benefits of primary care social work for adults with complex health and social needs: a systematic review. Health Soc Care Community. 2018;26(1):1-13. doi:https://doi.org/10.1111/hsc.12337.

    Article  PubMed  Google Scholar 

  80. Sommers LS, Marton KI, Barbaccia JC, Randolph J. Physician, nurse, and social worker collaboration in primary care for chronically ill seniors. Arch Intern Med. 2000;160(12):1825-1833. doi:https://doi.org/10.1001/archinte.160.12.1825.

    Article  CAS  PubMed  Google Scholar 

  81. Cohen AJ, Russell LE, Elwy AR, et al. Adaptation of a social risk screening and referral initiative across clinical populations, settings, and contexts in the Department of Veterans Affairs Health System. Front Health Serv. 2022;2:958969. doi:https://doi.org/10.3389/frhs.2022.958969.

    Article  PubMed  Google Scholar 

  82. Shepardson RL, Johnson EM, Possemato K, Arigo D, Funderburk JS. Perceived barriers and facilitators to implementation of peer support in Veterans Health Administration Primary Care-Mental Health Integration settings. Psychol Serv. 2019;16(3):433-444. doi:https://doi.org/10.1037/ser0000242.

    Article  PubMed  Google Scholar 

  83. Sheahan KL, Goldstein KM, Than CT, et al. Women Veterans’ Healthcare Needs, Utilization, and Preferences in Veterans Affairs Primary Care Settings. J Gen Intern Med. 2022;37(Suppl 3):791-798. doi:https://doi.org/10.1007/s11606-022-07585-3.

    Article  PubMed Central  PubMed  Google Scholar 

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Funding

This work was undertaken as part of the US Department of Veterans Affairs, Primary Care Analytics Team. Funding was provided by the Veterans Health Administration, Office of Primary Care. Dr. Maciejewski received VA HSR&D funding (RCS 10–391, CIN 14–310).

Author information

Authors and Affiliations

  1. Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA

    Mayuree Rao MD, MS & Karin Nelson MD, MSHS

  2. General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA

    Mayuree Rao MD, MS & Karin Nelson MD, MSHS

  3. Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA

    Mayuree Rao MD, MS & Karin Nelson MD, MSHS

  4. Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA

    Liberty Greene MS, MEd & Donna M. Zulman MD, MS

  5. Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA

    Liberty Greene MS, MEd & Donna M. Zulman MD, MS

  6. Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA

    Matthew L. Maciejewski PhD

  7. Department of Population Health Sciences, Duke University, Durham, NC, USA

    Matthew L. Maciejewski PhD

  8. Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA

    Matthew L. Maciejewski PhD

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  1. Mayuree Rao MD, MS
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  2. Liberty Greene MS, MEd
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  3. Karin Nelson MD, MSHS
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  4. Matthew L. Maciejewski PhD
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  5. Donna M. Zulman MD, MS
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Correspondence to Mayuree Rao MD, MS.

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This work was presented at the 2022 Society of General Internal Medicine annual meeting in Orlando, FL, as a poster.

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Rao, M., Greene, L., Nelson, K. et al. Associations Between Social Risks and Primary Care Utilization Among Medically Complex Veterans. J GEN INTERN MED 38, 3339–3347 (2023). https://doi.org/10.1007/s11606-023-08269-2

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  • DOI: https://doi.org/10.1007/s11606-023-08269-2

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