Screening for social determinants of health in patients with systemic lupus erythematosus: A point-of-care feasibility study

OBJECTIVES: Social determinants of health (SDoH) can impact outcomes but are not routinely screened for in US outpatient rheumatology clinics. This study determined the feasibility of routine point-of-care SDoH screening among patients with systemic lupus erythematosus (SLE), and associated barriers and facilitators at the physician, care team, and patient levels. 

METHODS: This observational, prospective, mixed methods pilot study (GSK Study 219011) conducted in two large, academic tertiary lupus clinics in the US, screened adults with SLE for SDoH over 2 weeks (Institution 1, July-August 2023) and 7 weeks (Institution 2, August-October 2023). Patient demographics and patient-reported responses to questions covering up to eight SDoH domains chosen by participating institutions were collected, and an optional patient experience survey was conducted afterwards. Participating physicians and care teams were asked questions on screening implementation, tool usability and comprehension, clinician acceptance, and facilitators of use. Transcripts were analyzed using thematic analysis. 

RESULTS: The study included 69 patients with SLE across both institutions; 65 completed the patient experience survey. SDoH screening was successfully implemented with minimal disruption to clinical workflow and was viewed as valuable by physicians, care teams, and patients. Reported facilitators to successful SDoH screening included institutional leadership buy-in to address health equity and a brief screening tool format (≤5 minutes). Barriers included limited resources and insufficient time or training. 

CONCLUSION: With an appropriately resourced and trained care team, successful routine SDoH screening in lupus clinics is feasible, valuable to clinicians/care teams, and effective for connecting patients to needed social resources.