Literature Collection

IMPORTANCE: Health-related social risks are increasingly recognized as important contributors to health. Compared with individual screening, neighborhood measures are potentially a lower cost, scalable strategy for identifying social risk. OBJECTIVE: To inform health resource planning and social risk screening strategies by comparing self-reported vs neighborhood-level social risk with inpatient, emergency department (ED), and outpatient care. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional analysis of self-reported social risks measured during Medicaid enrollment and neighborhood-level social risk in relation to health care use was conducted. Members of Kaiser Permanente Northern California, a large integrated health care delivery system, who completed the Medicaid Integrated Outcomes Questionnaire from January 1, 2018, to February 29, 2020, were included. Analysis took place from January 8 to November 29, 2024. EXPOSURE: Neighborhood-level social risk (living in the least-resourced Neighborhood Deprivation Index quartile) and self-reported social risk (indicating a need or wanting help with finances, food, housing, or transportation domains). MAIN OUTCOMES AND MEASURES: Hospital and ED admissions, primary care, specialty care, mental health, and social work visits in the year prior to questionnaire completion. Multivariable negative binomial regression models were analyzed for each type of health care use, controlling for demographic characteristics and several health conditions (eg, asthma, hypertension, and chronic pain). RESULTS: Among 13 527 respondents (8631 [63.8%] female; 5289 [39.1%] aged 25-44 years; 2846 [21.0%] Asian, 1986 [14.7%] Black or African American, 3040 [22.5%] Hispanic, 4602 [34.0%] White, and 1053 [7.8%] other race or ethnicity), 33.8% in the most-resourced neighborhood reported at least 1 social risk vs 40.1% in the least-resourced quartile (P < .001). Individual- and neighborhood-level measures were each associated with ED visits (marginal effect estimate for both measures: 0.23; 95% CI, 0.17-0.29). Neither measure was associated with hospital admissions. Individual risk was associated with greater use of all outpatient services (ranging from primary care visit marginal effect estimate: 0.22; 95% CI, 0.13-0.31 to mental health visit marginal effect estimate: 1.21; 95% CI, 0.67-1.75). Neighborhood-level risk was not associated with most outpatient visits and was negatively associated with mental health visits. CONCLUSIONS AND RELEVANCE: In this cross-sectional study, associations were found for hospital and ED use but not outpatient visits, especially mental health visits. These findings suggest that individual social risk screening appears to provide distinct information compared with neighborhood social risk.

Social workers play an important role in assessing social determinants of health (SDH) and providing behavioral health services in integrated care settings. Evidence suggests that integrated care interventions improve quality of life and other patient outcomes. However, the ambiguous role of social workers on the interdisciplinary team, the lack of protocol in SDH screening and intervention, and restrictions due to healthcare reimbursement limit social workers' ability to intervene. Future directions include standardizing integrated care models, evaluating integrated care's efficacy to address SDH, incorporating SDH into interprofessional training including role clarification and reimbursing for SDH assessment and intervention.

OBJECTIVE: We sought to evaluate the relationship between social determinants of health and physician-based mental healthcare utilization and virtual care use among children and adolescents in Ontario, Canada, during the COVID-19 pandemic. METHODS: This population-based repeated cross-sectional study of children and adolescents (3-17 years; N = 2.5 million) used linked health and demographic administrative data in Ontario, Canada (2017-2021). Multivariable Poisson regressions with generalized estimating equations compared rates of outpatient physician-based mental healthcare use during the first year of the COVID-19 pandemic with expected rates based on pre-COVID patterns. Analyses were conducted by socioeconomic status (material deprivation quintiles of the Ontario Marginalization index), urban/rural region of residence, and immigration status. RESULTS: Overall, pediatric physician-based mental healthcare visits were 5% lower than expected (rate ratio [RR] = 0.95, 95% confidence interval [CI], 0.92 to 0.98) among those living in the most deprived areas in the first year of the pandemic, compared with the least deprived with 4% higher than expected rates (RR = 1.04, 95% CI, 1.02 to 1.06). There were no differences in overall observed and expected visit rates by region of residence. Immigrants had 14% to 26% higher visit rates compared with expected from July 2020 to February 2021, whereas refugees had similarly observed and expected rates. Virtual care use was approximately 65% among refugees, compared with 70% for all strata. CONCLUSION: During the first year of the pandemic, pediatric physician-based mental healthcare utilization was higher among immigrants and lower than expected among those with lower socioeconomic status. Refugees had the lowest use of virtual care. Further work is needed to understand whether these differences reflect issues in access to care or the need to help inform ongoing pandemic recovery planning.

Nurse practitioner (NP) and physician assistant (PA) prescribing can increase access to buprenorphine treatment for opioid use disorder. In this cross-sectional study, we used deidentified claims from approximately 90% of U.S. retail pharmacies (2017-2018) to examine the association of state policies with the odds of receiving buprenorphine treatment from an NP/PA versus a physician, overall and stratified by urban/rural status. From 2017 to 2018, the percentage of buprenorphine treatment episodes prescribed by NPs/PAs varied widely across states, from 0.4% in Alabama to 57.2% in Montana. Policies associated with greater odds of buprenorphine treatment from an NP/PA included full scope of practice (SOP) for NPs, full SOP for PAs, Medicaid pay parity for NPs (reimbursement at 100% of the fee-for-service physician rate), and Medicaid expansion. Although most findings with respect to policies were similar in urban and rural settings, the association of Medicaid expansion with NP/PA buprenorphine treatment was driven by rural counties.