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Risks and Needs: Lessons Learned from Assessing Patients Willingness to Receive Help for Social Risks in Primary Care [Social determinants and vulnerable populations]

Annals of Family Medicine

Population Studied: 13 urban and rural primary care practices located across Mayo Clinic sites in Minnesota, Wisconsin, and Florida. Setting or Dataset: Secondary data on social needs screening and referral generated through Epic.

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Compass Rose for Generating Community-based Referrals via Epic: Best Practices and Lessons Learned [Social determinants and vulnerable populations]

Annals of Family Medicine

Population Studied: Three sites, representing 13 urban and rural primary care practices in Minnesota, Wisconsin, and Florida participated in the Compass Rose pilot. The most common type of support requested related to transportation needs (42%), followed by assistance related to food insecurity (25%), utilities (12%), and housing (9%).

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Addressing diabetes management in the context of social needs: a qualitative study of primary care providers [Diabetes and endocrine disease]

Annals of Family Medicine

Objective: To describe how primary care clinics have considered social needs in DM, and identify opportunities to support primary care clinics. family medicine, general internal medicine, endocrinology) affiliated with an academic medical center serving a diverse population in a mid-western metropolitan area.

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MN Legislative Session 2025: MAFP Priorities Remain in Play

Minnesota Academy of Family Physicians

As our state legislature gets closer to special session, the Minnesota Academy of Family Physician’s (MAFP) lobbyist Megan Verdeja breaks down what’s happening at the Minnesota State Capitol and provides a recap of the 2025 session. MAFP Priorities Many of the MAFP’s legislative priorities remain active in ongoing health care negotiations.

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Relationship between Social Risks and Colorectal Cancer Screening/Surveillance in a Large US Health System [Social determinants and vulnerable populations]

Annals of Family Medicine

Implementation of electronic health record SDOH questionnaires is more common in health care institutions and allows for individual-level assessment of social risk in a primary care setting. Significant differences may exist among screening and surveillance populations.

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Relationship between Social Risks and Diabetes Metrics in a Large US Health System [Social determinants and vulnerable populations]

Annals of Family Medicine

Primary care settings may be an appropriate environment to address social risk factors, however much is not known about the characteristics of patient reported social risk among patients with diabetes in a general primary care setting. Context Type 2 diabetes impacts 11.3%

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Association between patient reported social risks and HOUSES index: A rural-urban comparison [Social determinants and vulnerable populations]

Annals of Family Medicine

vs 3.4%, transportation risk 3.3% Conclusions SES as measured by HOUSES index is the predominant driver of patient-reported social risk among both urban and rural populations in this primary care population. Further evaluation is needed to apply use of social risk questionnaires and HOUSES index in primary care settings.