Added social needs interventions don’t necessarily lead to less hospital use

Additional screenings to help primary care patients find solutions for social needs did not necessarily lead to less use of health care services.

Researchers examined whether enhanced pharmacy care to help patients find solutions for health-related social needs might reduce patient hospitalization and emergency department visits. But that was not the case among 364 adult patients in a large safety-net hospital in Boston, Massachusetts, from May 2019 to March 2021, with a year of follow-up.

“These findings suggest that enhancing pharmacy services for patients with high levels of health care utilization does not lead to reduced health care utilization,” said the study published Jan. 9 in JAMA Network Open. The researchers and Boston Medical Center also published a news release about the results.

In the study, pharmacy technicians trained in motivational interviewing and patient navigation asked patients about eight domains of health-related social needs. Those included housing insecurity, food insecurity, trouble paying for medications, transportation to medical appointments, or for utilities, need for employment or education, and difficulty caring for children or other family members. The technicians asked patients if they wanted help connecting to resources, and offered literature or referrals to patients who wanted them.

“Patients in low-resource communities served by Medicaid Accountable Care Organizations struggle” with those needs, said a summary included with the news release. “Patients with unmet health-related social needs are at high risk for preventable healthcare use and high levels of medical expenditure and may prioritize social needs over medical care, which may lead to preventable utilization.”

But the interventions did not lead to less time at the hospital for admissions or emergency visits, according to the study. The findings were not surprising because interventions in health care settings must overcome “longstanding and intractable structural racism,” the study said.

“Given that the majority of study participants identified as members of a racial or ethnic group bearing a disproportionate burden of inequities in health care, it is unsurprising that a health system-based intervention did not improve outcomes,” coauthor Pablo Buitron de la Vega, MD, MSc, said in the news release. Buitron de la Vega is a general internist and preventive medicine physician at Boston Medical Center and assistant professor of medicine at Boston University Chobanian & Avedisian School of Medicine.

“There needs to be interventions outside of the health care setting,” Buitron de la Vega said. “Policies to reduce income inequality would be more likely to improve health outcomes.”