332 The Hidden Factors of Health: A Mixed Methods Study of EMS Provider Knowledge and Perceptions of Social Risk Factors

Abstract

Study ObjectivesSocial risk factors (SRF), including food and housing insecurity, health literacy and access, and substance abuse, are adversities that negatively impact patients’ health. Often the first point of contact with the health care system for patients, Emergency Medical Services (EMS) providers are well poised to initiate addressing these SRF and thereby improve patient care. However, current EMS training rarely includes SRF, and EMS reporting systems concentrate on medical information, excluding or sidelining SRF. The objective of this study was to understand EMS providers’ knowledge and perceptions of SRF, in addition to understanding areas for improvement concerning SRF in communities and health care systems.MethodsThis study included a qualitative and quantitative analysis of data gathered from EMS provider focus groups from a large New York-based EMS system. A secure online workspace was used to sample participants, resulting in three separate focus group sessions which were conducted between November-December 2021 (n= 7, 6 and 6, respectively). The focus group sessions were recorded and transcribed for thematic qualitative analysis using a six-phase inductive approach. An electronic survey was sent to participants upon the completion of each session, of which provided quantitative data regarding participants’ roles, training, and encounters with SRF.ResultsThere were 19 total participants over the three focus group sessions, with 11 completing the post-session survey. The majority of participants were male (68.4%) and paramedic trained (42.1% paramedic, 26.3% critical care paramedic). Three major themes identified as part of the focus group sessions and were as follows: SRF knowledge and perceptions, barriers to reporting and documenting SRF, and facilitators to reporting and documenting SRF. EMS providers had a comprehensive knowledge of SRF and perceived them to negatively impact health in various ways. Frequently reported SRF encountered by providers on emergency calls were financial, housing insecurity, health literacy, health insurance, substance use, and access to resources. EMS providers reported they observed these risk factors in half of their daily calls (median= 50%). Although the majority of participants indicated that they do not have a specific method to identify SRF, 90.9% indicated that they physically report them “at least some of the time” or more. Identified barriers to reporting included lack of follow up, workload, patient interactions, and lack of infrastructure in both the out-of-hospital and hospital setting. Education for patients and providers as well as community-based support would improve how SRF are addressed. In the follow up survey, of those that responded, about half of participants (54.5%) had never received formal training about SRF. All providers that responded were interested in receiving formal training on SRF.ConclusionThis study found that while EMS providers recognize SRF as a major implication for patient outcomes following emergency calls, there are multiple barriers to reporting these SRF and improving patient care. Implementation of a formal infrastructure and education for providers, patients, and communities could work towards improving this gap between necessity and current capability to address SRF in the out-of-hospital setting.No, authors do not have interests to disclose Study ObjectivesSocial risk factors (SRF), including food and housing insecurity, health literacy and access, and substance abuse, are adversities that negatively impact patients’ health. Often the first point of contact with the health care system for patients, Emergency Medical Services (EMS) providers are well poised to initiate addressing these SRF and thereby improve patient care. However, current EMS training rarely includes SRF, and EMS reporting systems concentrate on medical information, excluding or sidelining SRF. The objective of this study was to understand EMS providers’ knowledge and perceptions of SRF, in addition to understanding areas for improvement concerning SRF in communities and health care systems. Social risk factors (SRF), including food and housing insecurity, health literacy and access, and substance abuse, are adversities that negatively impact patients’ health. Often the first point of contact with the health care system for patients, Emergency Medical Services (EMS) providers are well poised to initiate addressing these SRF and thereby improve patient care. However, current EMS training rarely includes SRF, and EMS reporting systems concentrate on medical information, excluding or sidelining SRF. The objective of this study was to understand EMS providers’ knowledge and perceptions of SRF, in addition to understanding areas for improvement concerning SRF in communities and health care systems. MethodsThis study included a qualitative and quantitative analysis of data gathered from EMS provider focus groups from a large New York-based EMS system. A secure online workspace was used to sample participants, resulting in three separate focus group sessions which were conducted between November-December 2021 (n= 7, 6 and 6, respectively). The focus group sessions were recorded and transcribed for thematic qualitative analysis using a six-phase inductive approach. An electronic survey was sent to participants upon the completion of each session, of which provided quantitative data regarding participants’ roles, training, and encounters with SRF. This study included a qualitative and quantitative analysis of data gathered from EMS provider focus groups from a large New York-based EMS system. A secure online workspace was used to sample participants, resulting in three separate focus group sessions which were conducted between November-December 2021 (n= 7, 6 and 6, respectively). The focus group sessions were recorded and transcribed for thematic qualitative analysis using a six-phase inductive approach. An electronic survey was sent to participants upon the completion of each session, of which provided quantitative data regarding participants’ roles, training, and encounters with SRF. ResultsThere were 19 total participants over the three focus group sessions, with 11 completing the post-session survey. The majority of participants were male (68.4%) and paramedic trained (42.1% paramedic, 26.3% critical care paramedic). Three major themes identified as part of the focus group sessions and were as follows: SRF knowledge and perceptions, barriers to reporting and documenting SRF, and facilitators to reporting and documenting SRF. EMS providers had a comprehensive knowledge of SRF and perceived them to negatively impact health in various ways. Frequently reported SRF encountered by providers on emergency calls were financial, housing insecurity, health literacy, health insurance, substance use, and access to resources. EMS providers reported they observed these risk factors in half of their daily calls (median= 50%). Although the majority of participants indicated that they do not have a specific method to identify SRF, 90.9% indicated that they physically report them “at least some of the time” or more. Identified barriers to reporting included lack of follow up, workload, patient interactions, and lack of infrastructure in both the out-of-hospital and hospital setting. Education for patients and providers as well as community-based support would improve how SRF are addressed. In the follow up survey, of those that responded, about half of participants (54.5%) had never received formal training about SRF. All providers that responded were interested in receiving formal training on SRF. There were 19 total participants over the three focus group sessions, with 11 completing the post-session survey. The majority of participants were male (68.4%) and paramedic trained (42.1% paramedic, 26.3% critical care paramedic). Three major themes identified as part of the focus group sessions and were as follows: SRF knowledge and perceptions, barriers to reporting and documenting SRF, and facilitators to reporting and documenting SRF. EMS providers had a comprehensive knowledge of SRF and perceived them to negatively impact health in various ways. Frequently reported SRF encountered by providers on emergency calls were financial, housing insecurity, health literacy, health insurance, substance use, and access to resources. EMS providers reported they observed these risk factors in half of their daily calls (median= 50%). Although the majority of participants indicated that they do not have a specific method to identify SRF, 90.9% indicated that they physically report them “at least some of the time” or more. Identified barriers to reporting included lack of follow up, workload, patient interactions, and lack of infrastructure in both the out-of-hospital and hospital setting. Education for patients and providers as well as community-based support would improve how SRF are addressed. In the follow up survey, of those that responded, about half of participants (54.5%) had never received formal training about SRF. All providers that responded were interested in receiving formal training on SRF. ConclusionThis study found that while EMS providers recognize SRF as a major implication for patient outcomes following emergency calls, there are multiple barriers to reporting these SRF and improving patient care. Implementation of a formal infrastructure and education for providers, patients, and communities could work towards improving this gap between necessity and current capability to address SRF in the out-of-hospital setting.No, authors do not have interests to disclose This study found that while EMS providers recognize SRF as a major implication for patient outcomes following emergency calls, there are multiple barriers to reporting these SRF and improving patient care. Implementation of a formal infrastructure and education for providers, patients, and communities could work towards improving this gap between necessity and current capability to address SRF in the out-of-hospital setting.