Associations Between Social Risks and Primary Care Utilization Among Medically Complex Veterans

BackgroundSocial risks contribute to poor health outcomes, especially for patients with complex medical needs. These same risks may impact access to primary care services.ObjectiveTo study associations between social risks and primary care utilization among patients with medical complexity.DesignProspective cohort study of respondents to a 2018 mailed survey, followed up to 2 years after survey completion.ParticipantsNationally representative sample of 10,000 primary care patients in the Veterans Affairs (VA) health care system, with high (& GE; 75th percentile) 1-year risk of hospitalization or death.Main MeasuresSurvey-based exposures were low social support, no family member/friend involved in health care, unemployment, transportation problem, food insecurity, medication insecurity, financial strain, low medical literacy, and less than high school graduate. Electronic health record-based outcomes were number of primary care provider (PCP) encounters, number of primary care team encounters (PCP, nurse, clinical pharmacist, and social worker), and having & GE; 1 social work encounter.Key ResultsAmong 4680 respondents, mean age was 70.3, 93.7% were male, 71.8% White non-Hispanic, and 15.8% Black non-Hispanic. Unemployment was associated with fewer PCP and primary care team encounters (incident rate ratio 0.77, 95% CI 0.65-0.91; p = 0.002 and 0.75, 0.59-0.95; p = 0.02, respectively), and low medical literacy was associated with more primary care team encounters (1.17, 1.05-1.32; p = 0.006). Among those with one or more social risks, 18.4% had & GE; 1 social work encounter. Low medical literacy (OR 1.95, 95% CI 1.45-2.61; p < 0.001), transportation problem (1.42, 1.10-1.83; p = 0.007), and low social support (1.31, 1.06-1.63; p = 0.01) were associated with higher odds of & GE; 1 social work encounter.ConclusionsWe found few differences in PCP and primary care team utilization among medically complex VA patients by social risk. However, social work use was low, despite its central role in addressing social risks. More work is needed to understand barriers to social work utilization.

Automated summary

Social risks are associated with poorer health outcomes and may affect access to primary care services for patients with complex medical needs. Unemployment and low medical literacy are associated with fewer encounters with primary care teams, while low social support is associated with higher odds of social work encounters. However, utilization of social work services is low among patients with social risks, indicating a need to understand barriers to accessing these services.