[Evaluation of a coding guide on social determinants of health in primary care consultations: A mixed study]

OBJECTIVE

To evaluate a coding guide for social determinants of health in primary care consultations as an effective tool in the professional's daily workflow.

DESIGN

Mixed sequential explanatory study. Formed by a quantitative part (experimental) and a qualitative part (descriptive-evaluative).

LOCATION

All the primary care teams of the Central Catalonia Management (32 teams).

PARTICIPANTS AND SETTING

All nursing, social work and medical professionals working in the 32 primary care teams of the Catalan Institute of Health in Central Catalonia from February 2023 to July 2023.

METHODS

A social determinants of health coding guide was developed. This guide was created in a multidisciplinary and multicenter manner. Purposive sampling. Quantitatively, the number of diagnoses recorded by the experimental group versus the control group was counted. Qualitatively, a thematic analysis was carried out from a socio-constructivist perspective.

RESULTS

The results were significant and satisfactory. Using a quantitative methodology, the effectiveness of the use of the guide was assessed. A significant increase in the use of the social determinants was observed in the intervention group vs. the control group, with a percentage of post-intervention use of 19.53% in the control group and 32.26% in the intervention group (P < .001). The number of diagnoses recorded increased from 312 to 1322 in the intervention group, while it remained the same in the control group. The main factors identified through qualitative methodology that may explain the effectiveness of the guideline were: 1) the effectiveness of the guideline among primary care professionals, 2) the appropriateness of the guideline by assessing its usefulness and practicality, 3) feasibility and 4) specific contributions to the improvement of the guideline.

CONCLUSIONS

The social determinants of health coding guide is effective, appropriate and can be implemented in the workflow of primary health care professionals for good recording of the social determinants of health.

Recording of Social Determinants in Computerized Medical Records in Primary Care Consultations: Quasi-Experimental Study

BACKGROUND

 Social determinants of health may be more important than medical or lifestyle choices in influencing people's health. Even so, there is a deficit in recording these in patients' computerized medical histories. The Spanish administration and the World Health Organization are promoting the recording of diagnoses in computerized clinical histories with the aim of benefiting the individual, the professional, and the community. In most cases, professionals tend to record only clinical diagnoses despite evidence in the literature documenting that addressing the social determinants of health can lead to improvements in health and reductions in social disparities in disease.

OBJECTIVE

 This study aims to develop and evaluate the effectiveness of a mixed intervention (face-to-face-digital) aimed at improving the quantity and quality of the records of the social determinants of health in computerized medical records at primary care clinics.

METHODS

 A quasi-experimental, nonrandomized, controlled, multicenter study with 2 parallel study arms was conducted in the area of Central Catalonia (Spain) with primary care professionals of the Institut Català de la Salut (ICS), working from September 23, 2019, to March 31, 2020. All interested professionals were accepted. In total, 22 basic health areas were involved in the study. In Spain and Catalonia, the International Classification of Diseases is used, in which there is a coding of the social determinants of health. Five social determinants were selected by a physician, a nurse, and a social worker; these professionals had experience in primary care and were experts in community health. The choice was made taking into account the ease of use, benefit, and existing terminology. The intervention, based on the integration of a checklist, was integrated as part of the usual multidisciplinary clinical workflow in primary care consultations to influence the recording of these determinants in the patient's computerized medical record.

RESULTS

 After 6 months of implementing the intervention, the volume and quantity of records of 5 social determinants of health were compared, and a significant increase in the median number of pre- and postintervention diagnoses was observed (P≤.001). There was also an increase in the diversity of selected social determinants. Using the linear regression model, the significant mean increase of the experimental group with respect to the control group was estimated with a coefficient of 8.18 (95% CI 5.11-11.26).

CONCLUSIONS

 The intervention described in this study is an effective tool for coding the social determinants of health designed by a multidisciplinary team to be incorporated into the workflow of primary care practices. The effectiveness of its usability and the description of the intervention described here should be generalizable to any environment.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04151056; https://clinicaltrials.gov/ct2/show/NCT04151056.