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Patients enrolled in a program designed to help meet certain socioeconomic needs had modest but significant improvements in several key cardiovascular risk factors.
A study by Harvard Medical School investigators at Massachusetts General Hospital in collaboration with Health Leads—a Boston-based organization that helps health care delivery organizations connect patients with local services—found that enrollment in the Health Leads intervention helped patients improve blood pressure and cholesterol levels.
“We know that unmet basic resource needs for things like nutritious food, housing, transportation and medication are very common and are associated with poor health outcomes,” said Seth A. Berkowitz, HMS instructor in medicine at Mass General and corresponding author of the report published in JAMA Internal Medicine. “We’ve offered the Health Leads program at several of our internal medicine practices for the past few years, but we did not yet know whether this strategy for addressing patients’ unmet needs would lead to changes in clinical outcomes.”
The current study is a follow-up to one reported in a December 2015 paper in BMJ Quality & Safety. In that investigation by Berkowitz and his colleagues, primary care patients were screened for unmet social needs through a simple survey. Those expressing a desire for help were referred to Health Leads advocates located in the practices who then connected patients with local services to help meet the identified needs of most participants.
That study ran only seven months, not long enough to evaluate whether meeting those needs had any clinical effects. The current study was designed to investigate any impact.
Primary care patients seen at three Mass General primary care practices—including the two involved in the 2015 study—from October 2013 through April 2015 were surveyed regarding their desire for assistance with paying for healthy food, prescription medicine or utility bills; finding a job; or housing or other financial help.
Of more than 5,000 screened patients, 1,774 had at least one unmet need, and 1,021 of them agreed to enroll in the Health Leads program. Patients with unmet needs were more likely to be members of racial or ethnic minorities and to have less than a high-school education, a primary language other than English and Medicaid coverage.
Patients participating in the Health Leads program had an average of five contacts with their advocates and cases were open over an average of six weeks. At the end of the study period, almost 60 percent of the identified needs either had been met or patients indicated they no longer needed help. While around 35 percent of cases were classified as unsuccessful, more than 93 percent of these involved patients who stopped responding to contacts from their Health Leads advocates.
Based on a review of medical records for all screened patients—those with unmet needs who enrolled in Health Leads, those with unmet needs who did not enroll in Health Leads and those for whom no unmet needs were identified—Health Leads participants with hypertension had greater reductions in both systolic and diastolic blood pressure than did patients with hypertension not enrolled in Health Leads.
Participants with elevated LDL cholesterol levels who enrolled in Health Leads also saw greater improvement. No significant differences were seen in the HbA1c levels of Health Leads participants with diabetes.
“While we don’t know why there was no effect on blood sugar levels for participants with diabetes, improving dietary quality is probably the most important factor for improving HbA1c,” said Berkowitz.
“It’s possible that the resources people can be linked to for food are not as robust as are those assisting with medication, which is more important for blood pressure and cholesterol control,” Berkowitz said. “We do plan future studies to determine whether the program can be modified to better address blood sugar control and, eventually, whether these risk factor improvements actually reduce cardiovascular events.”
Rocco Perla, president of Health Leads and previously a senior official with the U.S. Centers for Medicare and Medicaid Services, said, “This study is one of the first to draw a positive association between social needs interventions and clinical outcomes and, it illuminates the potential impact of these programs across the health system on quality, cost and health.”
Adapted from a Mass General news release.
