BOSTON, MA — Patients in primary-care practices who had basic unmet needs and participated in a program that linked them with community resources had modest but significant improvements in blood pressure and LDL cholesterol 2 years later compared with patients who were not disadvantaged, in a new study[1].

The patients were screened in three clinics in Boston. If they reported that they had difficulties paying for basic needs such as medication, healthy food, or transportation, they could enroll in the Health Leads program and meet several times with a volunteer undergraduate advocate who would help them access food banks and pharmacy-assistance programs, for example.

The study by Dr Seth A Berkowitz (Massachusetts General Hospital, Boston) and colleagues was published December 12, 2016 in JAMA Internal Medicine.

“For a long time we’ve known that these unmet needs are associated with poor health, but we don’t really have a lot of evidence about whether helping people meet these needs actually improves their health,” Berkowitz told heartwire from Medscape. This study showed that this type of program was tied to clinically meaningful improvements in blood pressure and cholesterol, he noted.

“Interventions designed to link patients having unmet social needs with necessary resources in the community represent one potential strategy for improving health outcomes and reducing downstream health expenditures among vulnerable populations,” Dr Ashley M McMullen (University of California, San Francisco) and deputy editor of JAMA Internal Medicine Dr Mitchell H Katz (Los Angeles County Department of Health Services, California) write in an accompanying editorial[2].

“The findings in [this] study demonstrate that we can achieve measurable improvements in cardiometabolic outcomes by addressing unmet needs in the clinical setting,” they write.

But there is still room for improvement. “Additional efforts must be made to close the gap between identifying unmet needs and successfully connecting patients to indicated resources,” the editorialists stress, since “only slightly more than half of the patients who had unmet needs opted to enroll in the program, and only 58% of those who enrolled had their issue resolved through this program.”

“Hard to Manage Illness” if Food, Medicine Unaffordable

From October 2013 through April 2015, 5125 patients were screened. The patients had a mean age of 57, and 56% were women.

A total of 3351 patients had no unmet basic needs.

The remaining 1774 patients with at least one unmet basic need were more likely to be from a racial/ethnic minority and have a non-English primary language, Medicaid insurance, and less than a high school education.

Only 1021 of the disadvantaged patients (58%) enrolled in the Health Leads program. Of these, 259 patients (15%) declined to be referred to a resource and 329 patients (19%) declined services after an initial interview.

Of those who discussed their basic needs with an advocate, 30% successfully obtained what they needed; 28% received information to get what they needed; 34% did not successfully fill their need; and 7% had a rapid referral to a resource.

The patients who met with their advocates saw them a median of five times during a median follow-up of 33 months.

At study end, after adjustment for age, gender, race/ethnicity, education, language, health insurance, and clinical conditions, compared with patients who were not disadvantaged, patients who were disadvantaged and had enrolled in the program had significant decreases in systolic and diastolic blood pressure (-2.7 mm Hg and -1.5 mm Hg, respectively) and LDL cholesterol (-7 mg/dL; all P<0.001), but no significant difference in HbA1c.

Possibly patients had good access to therapies for hypertension and dyslipidemia, but patients with type 2 diabetes were not eating foods that are recommended for them, Berkowitz speculated.

“Most [clinicians] already recognize that if their patient can’t afford their medicines or their food, this is going to make it harder to manage their illness, but they probably didn’t know what they can do about it,” he added.

 This approach of linking disadvantaged patients with advocates who can help them, is “very doable” within a healthcare system. “A small number of people within a healthcare system may be able to make some progress,” according to Berkowitz.