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Original Investigation
February 2017

Addressing Unmet Basic Resource Needs as Part of Chronic Cardiometabolic Disease Management

Author Affiliations
  • 1Division of General Internal Medicine, Massachusetts General Hospital, Boston
  • 2Diabetes Population Health Research Center, Massachusetts General Hospital, Boston
  • 3Harvard Medical School, Boston, Massachusetts
  • 4Health Leads, Boston, Massachusetts
JAMA Intern Med. 2017;177(2):244-252. doi:10.1001/jamainternmed.2016.7691
Key Points

Question  Does screening for and addressing unmet basic resource needs in primary care help improve blood pressure and cholesterol and blood glucose levels?

Findings  The Health Leads program screens primary care patients for unmet basic needs, such as food, medication, housing, and transportation, and helps link those who report needs to community resources to address them. In a pragmatic evaluation, for 5125 patients screened, those who screened positive, and were encouraged to enter the program, saw statistically significant improvements in blood pressure and cholesterol levels, but not blood glucose level, compared with those who screened negative.

Meaning  Screening for and attempting to address unmet basic needs may help primary care be more effective.

Abstract

Importance  It is unclear if helping patients meet resource needs, such as difficulty affording food, housing, or medications, improves clinical outcomes.

Objective  To determine the effectiveness of the Health Leads program on improvement in systolic and diastolic blood pressure (SBP and DBP, respectively), low-density lipoprotein cholesterol (LDL-C) level, and hemoglobin A1c (HbA1c) level.

Design, Setting, and Participants  A difference-in-difference evaluation of the Health Leads program was conducted from October 1, 2012, through September 30, 2015, at 3 academic primary care practices. Health Leads consists of screening for unmet needs at clinic visits, and offering those who screen positive to meet with an advocate to help obtain resources, or receive brief information provision.

Main Outcomes and Measures  Changes in SBP, DBP, LDL-C level, and HbA1c level. We compared those who screened positive for unmet basic needs (Health Leads group) with those who screened negative, using intention-to-treat, and, secondarily, between those who did and did not enroll in Health Leads, using linear mixed modeling, examining the period before and after screening.

Results  A total of 5125 people were screened, using a standardized form, for unmet basic resource needs; 3351 screened negative and 1774 screened positive. For those who screened positive, the mean age was 57.6 years and 1811 (56%) were women. For those who screened negative, the mean age was 56.7 years and 909 (57%) were women. Of 5125 people screened, 1774 (35%) reported at least 1 unmet need, and 1021 (58%) of those enrolled in Health Leads. Median follow-up for those who screened positive and negative was 34 and 32 months, respectively. In unadjusted intention-to-treat analyses of 1998 participants with hypertension, the Health Leads group experienced greater reduction in SBP (differential change, −1.2; 95% CI, −2.1 to −0.4) and DBP (differential change, −1.0; 95% CI, −1.5 to −0.5). For 2281 individuals with an indication for LDL-C level lowering, results also favored the Health Leads group (differential change, −3.7; 95% CI −6.7 to −0.6). For 774 individuals with diabetes, the Health Leads group did not show HbA1c level improvement (differential change, −0.04%; 95% CI, −0.17% to 0.10%). Results adjusted for baseline demographic and clinical differences were not qualitatively different. Among those who enrolled in Health Leads program, there were greater BP and LDL-C level improvements than for those who declined (SBP differential change −2.6; 95% CI,−3.5 to −1.7; SBP differential change, −1.4; 95% CI, −1.9 to −0.9; LDL-C level differential change, −6.3; 95% CI, −9.7 to −2.8).

Conclusions and Relevance  Screening for and attempting to address unmet basic resource needs in primary care was associated with modest improvements in blood pressure and lipid, but not blood glucose, levels.

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