Annals of Family Medicine

NOVEMBER 20, 2024

Intervention/Instrument: The screening tool used in the pilot sites included five questions to assess needs related to transportation, food insecurity, utility payments, housing, and a final question to assess patients’ willingness to receive help.

Referral 130

Referral Community Transportation Utilities 130

Annals of Family Medicine

NOVEMBER 20, 2024

Instrument: The discussion guide included questions on 1) identifying shared social care priorities across the three groups, and 2) describing best practices, facilitators, and barriers around screening and referral for social needs learned from existing and past collaborative models.

Community 130

Community Diabetes Referral Screening 130

Annals of Family Medicine

NOVEMBER 20, 2024

Setting or Dataset: Secondary data on social needs screening and referral generated through Epic. Intervention/Instrument: The intervention includes a short survey to determine patients’ needs with respect to transportation, food insecurity, financial difficulty related to utility payments, and housing.

Primary Care 130

Primary Care Referral Routine Screenings Patients 130

Annals of Family Medicine

NOVEMBER 20, 2024

A recent review of national diabetes treatment guidelines recommended adjustments to DM to reduce financial strain (eg, selecting lower cost medications), as well as directly intervening in response to an identified social need (eg, referral to a community-based service). Setting: Ambulatory clinics (e.g.,

Primary Care 130

Primary Care Diabetes Management Provider 130

Annals of Family Medicine

NOVEMBER 20, 2024

family medicine, general internal medicine, endocrinology) at an urban academic medical center in the Midwest. Transportation and scheduling challenges also hindered engagement. Setting: Ambulatory clinics (e.g., All participants are referred to receive free produce ("standard of care").

Diabetes 130

Diabetes Clinic Transportation Internal Medicine 130

GeriPal

JANUARY 18, 2024

Jessie: And I mean, this is not what we’re seeing in terms of take a substance use disorder history is… Whatever our backgrounds, internists, family medicine, whatever our background brought us to hospice and palliative medicine, this is med school level substance use disorder history. ” Thoughts on that?

Illness 137

Illness Patient-Centered Screening Clinic 137