188 Prevalence of Social Resource and Legal Assistance Needs in the Emergency Department and the Relationship to Emergency Department Utilization

Abstract

Social inequities, particularly the lack of social resources, negatively impact health and are barriers to health care access and the effective delivery of care. We investigated the prevalence of social resource and legal assistance needs in an emergency department (ED) population; identified high-risk groups; and assessed the relationship between these needs and ED utilization. We conducted a prospective, cross-sectional study of a convenience sample of adult and pediatric patients presenting to a suburban academic emergency department with over 59,000 visits in 2013, seated in a county with household median income of $87,750 (165% of the national median). Trained undergraduate research assistants approached patients over a seven-week period and administered a scripted survey. We collected demographic information, including ethnicity, primary language, and household income. We screened for four categories of social resource need: health care-related (eg, lack of health insurance, lack of primary care physician), food insecurity-related, housing-related (eg, eviction, homelessness), and public benefits-related (government funded food assistance and income supplementation programs). Finally, we screened for legal assistance needs, defined as social resource needs that could require a lawyer to remedy, such as wrongful eviction. Chi-square analysis was performed to determine significance of categorical variables and their association with self-reported ED utilization. Of the 296 patients approached, 79% (234) completed screening, 59% (141) of those patients screened positive for at least one social resource need, and 32% (76) patients had at least two social resource needs. Further, 28% of patients had at least one social resource need that potentially required legal assistance. Health care-related needs were most prevalent, affecting 50% of patients. Food insecurity affected 26% of patients, while another 26% patients had housing-related needs. Eight percent of patients had difficulty obtaining public benefits. High-risk groups included patients living below 250% of the federal poverty level (FPL) and patients who were primarily Spanish-speaking. Patients living below 250% of the FPL were significantly more likely than those living above to have a social resource need (P<.001). Spanish-speaking patients were significantly more likely than English-speaking patients to have a social resource need (P<.001). Notably, having any social resource need was significantly correlated with having at least one self-reported ED visit in the prior month (P=.012) or year (P=.042). However, lack of health insurance and/or a primary care physician was not significantly correlated with ED utilization in the past month (P=.28 and P=.61, respectively). A significant proportion of ED patients have at least one social resource need and may require legal assistance to meet this need. These patients are significantly more likely to have used the ED in the last year and even in the last month, For these patients, EDs are not only their medical safety net but also may be their social safety net. We should explore innovative strategies, including medical-legal partnerships, for screening and addressing social resource needs in the ED in order to confront the needs that underlie patients’ ED utilization.