Families that include children with sickle cell disease (SCD) typically experience a high burden of social determinants of health. Researchers found that universal screening followed up with connecting patients with appropriate support and resources could ameliorate some of the burden. These findings were published in Pediatric Blood and Cancer.

Socioeconomic factors that affect health outcomes, such as access to safe housing and quality of job training, are considered to be social determinants of health. Patients with SCD have a chronic illness and are typically minorities, both of which can increase susceptibility to a high burden of social determinants of health. Clinically implemented, guideline-recommended universal screening and resource referral programs could improve social determinants of health for these vulnerable pediatric patients and their caregivers.

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In this study, researchers introduced universal screening for social determinants of health via a paper screener into a pediatric hematology clinic. Of 267 patient visits between August 2017 and November 2018, 156 visits covering 132 unique patients and their caregivers included a completed screen. Researchers used the WECARE questionnaire, which assessed food, education, transportation to the hospital, childcare, adequate housing, utilities, ability to pay for medications, and employment.

Of screened patients, 66% were positive for at least 1 unmet socioeconomic need, and 80% of patients with positive screens were referred to a pertinent community organization. Food was the most frequently unmet social determinant of health (25.6% of screens), followed by utilities and education (24.3% each), employment (19.2%), transportation to the hospital (14.1%), adequate housing (10.9%), available childcare (7.7%), and ability to pay for medication (2.6%).

Furthermore, 45% of families with whom a social worker followed up reported they had reached out to a community organization. In families where an imminent social need was present, an appointment with the social worker was scheduled.

The researchers noted that this study was designed to improve care for the patients at their clinic rather than to assess correlation or causation. Because of this, conclusions about the efficacy of this specific intervention cannot be made, though future studies could evaluate whether this method of intervention improves the burden of social determinants of health faced by many families of children with SCD. However, they noted that screening and referral programs were feasible to implement and were met with positive reception from patients.

“Currently, household income, zip code, and insurance type are proxies for poverty correlated with outcomes, but in many scenarios, they may be too blunt to identify a mechanism,” the researchers wrote. “Breaking poverty into more granular components might allow for an analysis of associations and causes, leading to concrete interventions through which we can improve our patients’ health and well-being.”

Reference

1. Power-Hays A, Li S, Mensah A, Sobota A. Universal screening for social determinants of health in pediatric sickle cell disease: A quality-improvement initiative [published online October 1, 2019]. Pediatr Blood Cancer. doi:10.1002/pbc.28006