Abstract
BackgroundPoverty is associated with increased morbidity related to multiple child and adult health conditions and increased risk of premature death. Despite robust evidence linking income and health, and some recommendations for universal screening, poverty screening is not routinely conducted in clinical care.MethodsWe conducted an exploratory study of implementing universal poverty screening and intervention in family medicine and a range of pediatric care settings (primary through tertiary). After attending a training session, health care providers (HCPs) were instructed to perform universal screening using a clinical poverty tool with the question “Do you ever have difficulty making ends meet at the end of the month?” for the three-month implementation period. HCPs tracked the number of patients screened and a convenience sample of their patients were surveyed regarding the acceptability of being screened for poverty in a healthcare setting. HCPs participated in semi-structured focus groups to explore barriers to and facilitators of universal implementation of the tool.ResultsTwenty-two HCPs (10 pediatricians, 9 family physicians, 3 nurse practitioners) participated and 150 patients completed surveys. Eighteen HCPs participated in focus groups. Despite the self-described motivation of the HCPs, screening rates were low (9% according to self-reported numbers). The majority of patients either supported (72%) or were neutral (22%) about the appropriateness of HCPs screening for and intervening on poverty. HCPs viewed poverty as relevant to clinical care but identified time constraints, physician discomfort, lack of expertise and habitual factors as barriers to implementation of universal screening.ConclusionsPoverty screening is important and acceptable to clinicians and patients. However, multiple barriers need to be addressed to allow for successful implementation of poverty screening and intervention in health care settings.
Highlights
Poverty is associated with increased morbidity related to multiple child and adult health conditions and increased risk of premature death
The Ontario College of Family Physicians recommends a clinical poverty tool [16, 17] to screen all patients for poverty using the question “Do you ever have difficulty making ends meet at the end of the month?” This question has a sensitivity of 98% [18] and a specificity of 40% [19] to identify people living below the poverty line
Implementation of such practice level improvements is not supported by any province-wide initiatives in Ontario and little is known about the feasibility and acceptability of implementing clinical poverty tools within Ontario primary care pediatric and family medicine practices
Summary
Poverty is associated with increased morbidity related to multiple child and adult health conditions and increased risk of premature death. Despite robust evidence linking income and health, and some recommendations for universal screening, poverty screening is not routinely conducted in clinical care. The Canadian Pediatric Society has included recommendations related to screening for poverty within evidence informed guides such as the Rourke Baby Record [20] and the Grieg Health Record for children and adolescents [21]. Implementation of such practice level improvements is not supported by any province-wide initiatives in Ontario and little is known about the feasibility and acceptability of implementing clinical poverty tools within Ontario primary care pediatric and family medicine practices
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