Implement social interventions in primary care

Identify patients with financial strain 

• Screen all patients using a key question identified as a good predictor from the Alberta's Poverty: A Clinical Tool for Primary Care Providers and teams
• Financial strain can be invisible and is not always apparent.

FULL STORY HERe

“Do you ever have difficulty making ends meet at the end of the month?” (Sensitivity 98 per cent, specificity 40 per cent for living below the poverty line)

Assess the patient's situation

Ask everyone: “Have you filled out and sent in your tax forms?” Tax returns are required to access many income security benefits including: GST / HST credits, child benefits, working income tax benefits, and property tax credits. Most communities have free income tax clinics 

• Ask about their employment, living situation (are they at risk of losing a home?), social supports (do they live alone? Who would you ask for help? Have they recently immigrated?), and other benefits they receive. Consider using a care plan template inclusive of social needs.
• Explore what is important to them. 
• Document your assessments.

Plan ways to support financial needs together

• Explain how important it is to work towards addressing financial strain to improve health
• Make the connection about how addressing financial strain can also enhance the impact of other care recommendations
• Establish common goals

• Schedule a series of visits with the primary care team to intervene, educate and support patients to access and connect them with resources and services.
  • Intervening can have a profound impact on your patients’ health.  
  • Financial strain can affect food security, child care, transportation, and seniors’ care, requiring referral to appropriate services (food banks, meal programs, parenting centres, home care).
  • Review the Benefits Finder (services.gc.ca)
  

  A powerful body of evidence shows financial strain puts patients at higher risk for cardiovascular diseases, diabetes and depression. Children in low-income families are at higher risk of low birth weights, mental health problems, asthma, malnutrition, injuries and hospitalization. Financial strain also leads to poor diet, lack of exercise, substance abuse and high-risk sexual behaviour.

Build relationships with and connect patients with community supports

• Call 211 Alberta, Information on social, community, health and government services in Alberta
• Browse 211 website to find community supports, advocacy organizations, and financial supports
• Expand the care team by discovering key community navigators, social care providers, coalitions and/or non-profit organizations that support individuals with financial strain

Reducing the Impact of Financial Strain in the Patient's Medical Home (albertadoctors.org)

Intended to help physicians and team members implement practice changes that improve care for patients living with financial strain in conjunction with quality improvement. Provides potentially better practices from a review of the literature, clinical practice guidelines, and from expert recommendations. 

CEP Providers | Poverty 

Poverty: A Clinical Tool for Primary Care directs providers to use key questions to assess their patients’ living situations and current benefits and includes links to key government and community resources to support positive interventions.

Implementing social interventions in primary care | CMAJ

Discuss accumulated evidence on social interventions and provide an overview of common primary care–based interventions, highlighting their strengths, limitations and feasibility of implementation in different practice settings. Provides levels of practice resources that would facilitate their implementation, and also suggest those interventions that could be led by an external community partner.