Emergency department-based interventions affecting social determinants of health in the United States: A scoping review.

Autor: Walter LA; Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Schoenfeld EM; Department of Emergency Medicine, University of Massachusetts Medical School-Baystate Medical Cente, Springfield, Massachusetts, USA., Smith CH; Lister Hill Library, University of Alabama at Birmingham, Birmingham, Alabama, USA., Shufflebarger E; Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Khoury C; Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Baldwin K; University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA., Hess J; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Heimann M; Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Crosby C; Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Sontheimer SY; University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA., Gragg S; ChristianaCare EM/IM Residency Program, Newark, Delaware, USA., Hand D; Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., McIlwain J; University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA., Greene C; Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Skains RM; Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA., Hess EP; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Jazyk: angličtina
Zdroj: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine [Acad Emerg Med] 2021 Jun; Vol. 28 (6), pp. 666-674. Date of Electronic Publication: 2021 Feb 02.
DOI: 10.1111/acem.14201
Abstrakt: Background: Social determinants of health (SDoH) have significant implications for health outcomes in the United States. Emergency departments (EDs) function as the safety nets of the American health care system, caring for many vulnerable populations. ED-based interventions to assess social risk and mitigate social needs have been reported in the literature. However, the breadth and scope of these interventions have not been evaluated. As the field of social emergency medicine (SEM) expands, a mapping and categorization of previous interventions may help shape future research. We sought to identify, summarize, and characterize ED-based interventions aimed at mitigating negative SDoH.
Methods: We conducted a scoping review to identify and characterize peer-reviewed research articles that report ED-based interventions to address or impact SDoH in the United States. We designed and conducted a search in Medline, CINAHL, and Cochrane CENTRAL databases. Abstracts and, subsequently, full articles were reviewed independently by two reviewers to identify potentially relevant articles. Included articles were categorized by type of intervention and primary SDoH domain. Reported outcomes were also categorized by type and efficacy.
Results: A total of 10,856 abstracts were identified and reviewed, and 596 potentially relevant studies were identified. Full article review identified 135 articles for inclusion. These articles were further subdivided into three intervention types: a) provider educational intervention (18%), b) disease modification with SDoH focus (26%), and c) direct SDoH intervention (60%), with 4% including two "types." Articles were subsequently further grouped into seven SDoH domains: 1) access to care (33%), 2) discrimination/group disparities (7%), 3) exposure to violence/crime (34%), 4) food insecurity (2%), 5) housing issues/homelessness (3%), 6) language/literacy/health literacy (12%), 7) socioeconomic disparities/poverty (10%). The majority of articles reported that the intervention studied was effective for the primary outcome identified (78%).
Conclusion: Emergency department-based interventions that address seven different SDoH domains have been reported in the peer-reviewed literature over the past 30 years, utilizing a variety of approaches including provider education and direct and indirect focus on social risk and need. Characterization and understanding of previous interventions may help identify opportunities for future interventions as well as guide a SEM research agenda.
(© 2020 by the Society for Academic Emergency Medicine.)
Databáze: MEDLINE
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