Wednesday, July 1, 2015

Training in Social Determinants of Health in Primary Care: Does it Change Resident Behavior?

Melissa Klein, MD, MEd
Cincinnati Children's Hospital Medical Center

Objective: To examine the effects of a new social determinants of health curriculum on pediatric interns' attitudes, knowledge, documentation, and clinical practice.

Methods: A non-randomized mixed methods study of an educational intervention conducted over a one-year period was performed. The 2008-09 pediatric interns (intervention group) participated in a new social determinants of health curriculum; prior year interns were controls. An anonymous online survey at the end of internship to both groups (post-tests) and the beginning of internship to the intervention group (pre-test) assessed attitudes and knowledge. Documentation from the electronic medical record of social history questions was audited during the same 3 month period in successive years. Medical Legal Partnership (MLP) referrals from both groups were compared.
Results: Intervention interns (n=20) were more comfortable discussing issues (100%/71%, p<0.01) and felt more knowledgeable regarding issues (100% /64%, p=0.005), community resources (94%/29%, p<0.001), and housing (39%/6%, p=0.04) than control group interns (n=18). No differences regarding the importance of social hardships or screening for food security or education issues were found. Knowledge was greater in the intervention group post-test in all domains: benefits (72%/52%), housing (48%/21%), and education (52%/33%, p<0.001 for all). Intervention interns were more likely to document each issue (benefits 98%/60%, housing 93%/57%, food 74%/56%; p<0.001 for all). The intervention group had a slightly higher rate of referral to MLP, although the difference did not reach statistical significance
Conclusion: The educational intervention increased interns' comfort and knowledge of social determinants of health and community resources. Documentation of social questions also increased.