Assistant Professor Rush University Medical Center Chicago, Illinois, United States
Objectives: To quantify the need for additional social support services in an outpatient general rehabilitation clinic setting.
Design: Retrospective chart review was performed to assess how many social work consultations were made in the 6 months prior to instituting a structured social determinants of health screening for every patient and how may social work consultations were placed after instituting a structured social determinants of health screening.
Results: In the 6 month period prior to instituting a structured social determinants of health screening for every patient, there were 50 referrals to the department of social work. In the 6 months after instituting a structured social determinants of health screening for every patient, there were 146 referrals to the department of social work. The number of social work referrals tripled after instituting mandatory screening for every patient indicating that patients may not spontaneously share personal information regarding their social determinants of health such as issues with primary care, insufficient insurance coverage, food insecurity, transportation difficulties, inability to pay utilities, and impending homelessness. By not screening our outpatients for social determinants of health at each visit we were under serving a population already facing challenges due to their disability or injury.
Conclusions: Structured social determinants of health screening should be incorporated into every outpatient rehabilitation visit. Relying on the history taken by the medical providers or assuming that the patient will be forthright about what their social needs may be to determine whether a social work consultation is needed is likely to neglect a significant number of patients in need. Social determinants of health affect function, medical outcomes, and quality-of-life. As rehabilitation physicians it is our duty to take care of the whole patient which includes not only the medical aspects of their care but the social aspects that may impact function, healing, and quality of life.