Reducing Social Distress for Chronic Disease Patients in Primary Care: An Intervention for Latino Type 2 Diabetes Patients Seen at Community Health Centers.

Abstract

Background.Social and behavioral factors have important direct and indirect effects on chronic disease onset and progression. The U.S. health care system is beginning to focus on assessment and management of social and behavioral problems through federal mandates related to meaningful use of electronic health records and improved patient outcomes.Methods.We examined the clinical adoption of a 20-item screening tool to measure social distress focusing on type 2 diabetes. This Internet-based survey tool was embedded within a diabetes team care dashboard used to manage Latino patients with poorly controlled type 2 diabetes (n = 399) seen at urban safety-net clinics with referral as needed to clinical, community, and social services.Results.Results showed a high baseline prevalence of many of the 20 social distress issues assessed. The control group had a mean 6.8 ± 4.3 items at baseline and 6.2 ± 4.3 items at 6 months; the intervention group had a mean 7.2 ± 4.5 items at baseline and 5.6 ± 4.6 items at 6 months. The majority of participants (>90%) reported having one or more social distress issues during the previous week. Moreover, 11 of 20 social distress items were identified by ≥30% of patients as being present. However, social distress was significantly reduced from our intervention based on a culturally sensitive team model focused on actively managing social distress issues compared to usual diabetes team care (P <0.01).Conclusion.Social distress issues are common but were significantly reduced with a 6-month diabetes team intervention involving initial screening followed by tailored diabetes education and referral to existing local services.