When and How Do We Need Permission to Help Patients Address Social Risk?

摘要

Amid mounting evidence that health care services have a relatively small impact on health outcomes, which is dwarfed by the influences of a patient’s social context, many health care institutions are clamoring to learn more about their patients’ social risks. Increasing numbers of clinics, hospitals, and emergency departments are now administering social risk screening questionnaires or asking about the social, economic, and behavioral risk factors of their patients in other ways.1,2 In their commentary in this issue, De Marchis et al (2020) describe the rapid proliferation of these efforts, supported by national recommendations from esteemed organizations, such as the National Academies of Science, Engineering and Medicine, to continue doing so.1,3 These efforts are being undertaken to more clearly identify subsets of vulnerable patients who have social risk factors that can be addressed by health care providers through various means (eg, referrals to social service agencies, increased intensity of care management services, embedding behavioral health providers into clinics and hospitals, food pantries, enhanced child care, and transportation offerings). In turn, these interventions to address patients’ heightened social risks might result in shorter hospital stays, less frequent emergency department visits, reductions in preventable readmissions, and improved overall health of patient populations for which a system is accountable (and for whom the system is likely assuming some financial risk). De Marchis et al (2020) shine a spotlight on an interesting paradox that is emerging in this flurry of activity: although patients are often willing to report social risks to their health care providers, many patients do not want help in addressing them.