Universal Screening Tool for Socioeconomic Needs May Improve Care of Children with SCD, Study Suggests

Universal screening to identify socioeconomic needs of children and families affected by sickle cell disease can help to address their specific difficulties, and ultimately improve the healthcare of those with the disease, a study suggests.

The study, “Universal screening for social determinants of health in pediatric sickle cell disease: A quality‐improvement initiative,” was published in the journal Pediatric Blood & Cancer.

Socioeconomic differences are major obstacles to proper and equal healthcare. The World Health Organization has identified social determinants of health (or SDoH) as “mostly responsible for health inequities — the unfair and avoidable differences in health status — seen within and between countries.”

In the United States, socioeconomic status is thought to have greater influence on overall health outcomes than the medical care provided to patients. This has led the American College of Physicians and the American Academy of Pediatrics to recommend the implementation of universal screening protocols to identify SDoH and help connect affected families with local resources that address these specific socioeconomic needs.

The feasibility and application of such SDoH screening protocols has been demonstrated in pediatric oncology practices. However, it has not yet been addressed for the care of children affected by sickle cell disease.

Researchers from Boston Medical Center and Boston University School of Medicine explored the possibility of introducing universal screening for SDoH into the institution’s busy pediatric hematology clinic, and implemented the protocol between August 2017 and November 2018.

During this period, 267 patient visits were eligible to enter the screening protocol, with 156 (58%) visits completing the electronic medical record, which represented 132 patients included in the study.

The researchers used WECARE — a one-page, self-reported questionnaire that was previously validated — to proceed with the SDoH screening.

The questionnaire assessed issues related to adequate housing, food, employment, childcare, education, utilities, transportation to the hospital, and ability to pay for medications. The screening was offered in English, Spanish, and Haitian Creole, and in cases of low literacy, clinic staff read the questions to families.

Patients who reported SDoH-related needs or requested assistance for an identified SDoH problem were referred to a local community organization to address the specific need.

Using this approach, the team was able to identify 1.2 needs per SDoH screen across all 156 visits. In a total of 53 visits (34%), families reported no unmet socioeconomic needs, while 103 (66%) had at least one unmet socioeconomic need.

The most commonly reported problem was food insecurity (25.6%), followed by difficulty paying utilities (24.3%), and a desire for more education (24.3%). The percentage of patients who reported difficulty in paying for medication was low (3%), most likely “because Massachusetts has universal health insurance,” the researchers noted.

The families that showed some SDoH needs in the screen were later contacted by the clinic’s social workers for a follow-up consultation. Of the 70% of the families who answered the phone call, 45% said they intended to contact a community organization without any additional assistance from the clinic. Of those who reached out the organization, 69% stated that it was helpful.

This study demonstrates that a universal SDoH screening protocol can help overcome potential barriers preventing physicians from proactively asking their SCD patients about socioeconomic problems that could impact their health status.

“I had a patient I’ve known for years who seems well-off in a two-parent household, and for the first time ever the mother told me that they often have trouble paying their utilities in the winter,” one physician stated in the study.

The overall clinical team, including physicians, social workers, and clinical assistants, thought the screening produced positive results and identified more families with socioeconomic needs without impacting the clinic’s normal work flow.

“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,” the authors said.

“As pediatricians and hematologists, we want to improve the well-being of the whole patient, not just their blood disorder,” Alexandra Power-Hays, MD, a pediatrician at Boston Medical Center and lead author of the study, said in a press release. “Now that we’ve demonstrated that a simple method can begin addressing socioeconomic needs, we hope that pediatric hematologists across the country will also adopt this model for more long-term healing solutions.”