Patient Perspectives on Social Risk Screening and Documentation in a Dermatology Clinic.

Autor:	Wilkerson K; University of California, San Francisco School of Medicine, San Francisco., De Marchis E; Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco., Rudd N; University of California, San Francisco School of Medicine, San Francisco., Williams JC; University of California, San Francisco School of Medicine, San Francisco., Pantell M; Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco., Ackerman SL; Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco., Amerson EH; Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco.; Department of Dermatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California., Chang AY; Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco.; Department of Dermatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California.
Jazyk:	angličtina
Zdroj:	JAMA dermatology [JAMA Dermatol] 2023 Dec 01; Vol. 159 (12), pp. 1346-1358.
DOI:	10.1001/jamadermatol.2023.3887
Abstrakt:	Importance: Providing person-centered dermatologic care includes consideration of social risk factors, such as housing instability and unreliable transportation, that may affect clinical management. Patients' perspectives on social risk screening and documentation in dermatology clinics have not yet been evaluated. Objective: To understand patients' perspectives on social risk screening and documentation in a dermatology clinic. Design, Setting, and Participants: This mixed-methods study used a survey and semistructured interviews and was conducted in a general dermatology clinic at a large urban public hospital. Patients at the clinic were eligible to complete the survey if they were 18 years or older; able to speak and read English, Spanish, or Cantonese; and comfortable using a computer tablet. Survey participants who preferred to use English were eligible for interviews. The survey included social risk screening questions, measures of acceptability, and questions on social risk factors associated with patient acceptability. Semistructured interviews were conducted to explore attitudes and beliefs about social risk screening and documentation. Survey and interview findings were integrated during data analysis through development of themes and joint display. Data were analyzed from December 2021 to April 2023. Main Outcomes and Measures: There were 2 outcome measures of acceptability: appropriateness of screening in a dermatology clinic and comfort with documentation of social risk in the electronic health record (EHR). Results: A total of 135 participants (including 73 males [54.1%]) answered both measures of acceptability in the survey. Of these participants, 116 (85.9%) reported that social risk screening in their dermatology clinic was very or somewhat appropriate and 85 (63.0%) reported being completely or somewhat comfortable with having their social risks documented in the EHR. Themes that were developed from surveys and interviews were the (1) role of interpersonal factors in willingness to disclose social risks, (2) implications of institutional trust for willingness to disclose and comfort with documentation, and (3) relevance of screening in a dermatology clinic. Conclusions and Relevance: Results of this study showed that most participants found social risk screening to be appropriate in a dermatology clinic, although a smaller proportion of participants were comfortable with EHR documentation of their social risks. Optimizing patients' trust in their physicians and the medical system, while addressing privacy and discrimination concerns, may help facilitate disclosure of social risks.
Databáze:	MEDLINE
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