More Than Just Meds – Social Needs of ED Patients

Background

In our current healthcare system, Emergency Departments (ED) have become central to the health “safety net” of the nation.  Although Emergency Medicine is designed to provide acute medical care, its position within the healthcare system has created a dependence on EDs to address the complex social as well as medical situations with which patients present.  While most emergency physicians (EP) recognize the fundamental connection between social deprivation and health consequences there is little formal education in managing such issues in the clinical setting.

Primary Results

• Almost all respondents (95.7% of residents, 94.8% of attendings) ask about some type of social issue
• Majority (>80% of respondents) of questions around access to primary care, access to specialty care, dental care, insurance status, transportation, housing, and substance abuse. 
• Significant decrease in EP questioning in regards to more complex social issues such as debt/bankruptcy and access to food stamps. 
• Almost all respondents (99.5% academic, 100% county/academic, 98.6% community/academic, 100% county/community/academic) responded that social needs cause patients to return to the ED. 
• Reasons for not asking about more extensive social histories range from
  • feeling unable to act (54%)
  • lack of time (20%)
  • lack of knowledge (22%)
  • Less than 1% (4/432) of respondents felt “that addressing non-medical needs was not part of their job or that such needs were not relevant to patients’ health.”
• When social needs are recognized, respondents state that they
  • refer to social work (77%)
  • to outside agencies (32%)
  • try to solve these problems themselves (27%)
• Community and county hospital EPs were similar in their frequency of asking about social needs (98% and 93%, respectively). 
• Community providers were more likely than country providers to respond that they did not ask about social needs (7.04% v 1.71%, p=0.02).
• The majority of respondents (70.1% and 74.8% of residents and attendings, respectively) would be interested in attending educational sessions regarding social needs.

Strengths

• The survey gathers information on an important aspect of EM that has not been adequately studied
• Discussion offers some solutions to the lack of adequate training in social issues in medicine for EM trainees

Limitations

• By using CORD listserv, there was access to a “rich source of subjects”, but the limiting factor in responses was determined by the extent to which members of the listserv disseminated the survey. 
• Survey was focused on academic/training programs where more emphasis is placed on formal educational opportunities and may not reflect EP population at large.

Author's Conclusions

”This study highlights the fact that emergency department providers around the country see a large number of social needs. They identified specific needs that increase the utilization of healthcare services. These needs would more likely be addressed if greater referral resources were available.”

Our Conclusions

Emergency medicine as a specialty was created to address gaps in access to health care, in line with a “social medicine” framework. In our current healthcare system, the ED will continue to be a foundational aspect of the social safety net of our society. In addition, as the authors point out, with increased access to insurance coverage but without a primary access point for medical care, patients will present to the ED in more numbers and likely with increasing health-related social needs. To respond to such changes, EPs must be given formal education as well as access to resources to adequately address such issues.

Bottom Line

Social needs add a complexity to medical problems and should be addressed by EPs. More resources are needed for EPs and EDs to adequately realize this mission.

Read More

Zink B. Social Justice, Egalitarianism, and the History of Emergency Medicine. Virtual Mentor 2010; 12(6): 492-494. PMID: 23158453