Patient-reported social risk factor screening among rheumatology outpatients

OBJECTIVE: The purpose of this study was to pilot test a patient-reported social risk factor (SRF) screening tool among rheumatology outpatients and to examine the distribution of SRFs in this population. 

METHODS: A SRF screening tool was completed electronically by patients. Patients were screened for four core SRF domains (financial strain, housing instability, food insecurity, and transportation needs) and four supplemental SRF domains (physical inactivity, social isolation, stress, and depression). Data from the electronic health record were extracted for patients with at least one domain screened who were seen by participating rheumatology providers between January 1 and October 31, 2023. Descriptive statistics and multivariable logistic regressions were used to examine trends and associations of SRFs in this population. 

RESULTS: The sample included 483 patients, and 84% of patients screened positive for at least one SRF. Physical inactivity (73%, 311 of 429) and social isolation (58%, 212 of 367) were the most common SRFs. Prevalence of core SRF domains was 35% for financial strain (145 of 412), 22% for housing instability (82 of 370), 23% for food insecurity (96 of 420), and 11% for transportation needs (48 of 427). Sociodemographic groups with higher prevalence of SRFs included patients reporting Medicaid insurance, younger age, Black race, or unmarried status. Multivariate analyses showed that Medicaid insurance increased odds of reporting SRFs in all core domains. 

CONCLUSION: Our SRF screening identified a high burden of SRFs among rheumatology outpatients, giving a new level of detail into patients' barriers and possible needs. Future work will uncover associations between SRFs and clinical outcomes and evaluate the impact of interventions to address SRFs.