Primary care clinicians who adopt programs to address patients’ social needs are more effective at screening and assisting people who need help with food and housing, according to a new systematic review published in the Annals of Internal Medicine. However, the study found inconsistent evidence that tackling social needs leads to better clinical outcomes.

A growing number of clinicians have prioritized addressing social needs in recent years. US health systems invested an estimated $2.5 billion from 2017 to 2019 on social needs initiatives, according to a February 2020 study in Health Affairs. The new analysis looked at 23 studies of such programs embedded in primary care clinics that aimed to connect patients with help managing food insecurity, transportation, and housing.

“What we really concluded was that those small, targeted populations that were screened and intervened upon were really the ones where we’d seen the most of the programs succeed,” said study author Eva Chang, PhD, MPH, research scientist associate at Advocate Aurora Research Institute in Milwaukee, who led the study.

Most of the studies reviewed were of programs implemented in primary care settings at community health centers, private clinics, or academic medical centers, with one in the Veterans Health Administration. The types of assistance most clinics offered included providing a list of resources and help from staff in connecting patients, the review found.

The review divided programs into two categories: those that screened all patients and those that screened only individuals who were eligible because of a specific health condition, insurance type, or healthcare usage.

The review found programs that targeted all patients performed less screening, reaching up to 57.2% of the population. One program implemented across 581 community health centers had a screening rate of 1.9% among a total population of 1 million patients.

Clinics that screened only specific patients reached higher rates, up to 90.9%.

Nine studies examined the rate at which programs provided a resource list or handoff to nonprofit organizations for those who screened positive. Among programs that screened all patients, the highest rate at which individuals received this information was 57.6%, while the rate for targeted programs was up to 100%. Higher intervention rates were observed among programs with fewer than 500 participants.

“Those small, targeted populations that were screened and intervened upon were really the ones that succeeded in helping patients,” Chang said.

Among targeted programs, almost all patients who received referrals for assistance reported getting help compared with one quarter of patients who got referrals from all-patient programs.

Among the five studies in the review that reported clinical outcomes, only one program showed associations with improved blood pressure or controlled cholesterol among 1774 patients who screened positive for a social need. Three studies reported that patients showed no change in clinical outcomes, while another study reported that patients experienced worse blood pressure outcomes.

Two studies of programs with targeted populations showed reductions in emergency department visits and 30-day hospital readmissions among higher-need, high-cost patients.

Chang said wide variation in the design and approaches across screening and intervention programs made identifying best practices for addressing social needs difficult. But higher screening rates among programs that targeted more specific, smaller populations might suggest that starting small could increase efficacy by allowing time to work out workflow issues that could arise before scaling up to serve more patients.

Still, some clinicians contend their efforts to address social needs have already resulted in positive outcomes.

Brian Miller, MD, chief medical information officer and vice president of telehealth at the Toledo-based health system ProMedica in Ohio, said they started a social needs initiative a decade ago. Since then, he has observed an increase in primary care visits and declines in emergency department visits and hospital admissions at the health system.

In 2014, ProMedica began screening patients for food insecurity, which led them to create and run three food pantries. Miller, who was not involved in the new study, said taking a hands-on approach to address social needs has helped their patients feel more engaged about managing their health.

“If you can lower those barriers and provide a personal touch where patients know that there is a person in front of them who actually cares and is making sure that they get connected to resources — that is what makes all the difference,” he said.

The study was funded by the Live Well Intramural Pilot Grant Program through the Advocate Aurora Research Institute.

Steven Ross Johnson is a journalist who covers public health and healthcare delivery issues.