Screening for unmet basic needs improves blood pressure, cholesterol levels

Adults who participated in a program that screens patients for unmet basic needs such as food, medication, housing and transportation had significant improvements in blood pressure and cholesterol levels, although they had no improvement in their blood glucose level.

Lead researcher Seth A. Berkowitz, MD, MPH, of Massachusetts General Hospital in Boston, and colleagues published their results online Dec. 12 in JAMA Internal Medicine.

The researchers evaluated the Health Leads program at three academic internal medicine practices in the Boston metropolitan area. They analyzed adults who completed screening between Oct. 1, 2013, and April 30, 2015, and obtained electronic health record data.

During the Health Leads program, participants completed a screening form and identified whether they had unmet resource needs related to food, medications, transportation, utilities, employment, elder care services and housing. If they have unmet needs, they are referred to a staff member who determines if they should enroll in the program. Patients who enrolled in the program interact with staff members who helped them realize their unmet needs.

The researchers screened 5,125 adults, of whom 34.6 percent screened positive for at least one unmet resource need. Adults who screened positive were more likely to self-identify as a racial/ ethnic minority, have less than a high school diploma–level education, speak a primary language other than English and have Medicaid insurance than those who screened negative.

Of the adults who screened positive, 57.6 percent enrolled in the Health Leads program, 14.6 percent decline referral and 18.6 percent declined service after an initial interview. The cases were open for a median of 42 days, and participants received a median of five contacts from their advocate, who was typically an undergraduate student volunteer.

The researchers found that 29.7 percent of the adults said their needs were closed as successful, 27.9 percent said they were closed as equipped, 34.9 percent said they were closed as unsuccessful and 7.1 percent said they were handled with a rapid resource referral. They added that 93.2 percent of the participants who said the program was unsuccessful stopped responding when Health Leads advocates tried to contact them.

Unadjusted analyses of participants with hypertension found that those involved in the Health Leads program had a greater reduction in systolic blood pressure and diastolic blood pressure. Program participants also had a reduction in low-density lipoprotein (LDL) cholesterol. However, they did not have an improvement in hemoglobin A1c level.

The results were similar after adjusting for baseline demographic and clinical differences.

“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,” Berkowitz said in a news release. “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. 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.”

The researchers mentioned a few limitations of the study, including that the three practices already had advanced population health management programs that focused on blood pressure, cholesterol and HbA1c levels. Thus, they did not know if the findings would be generalizable to other practices without similar programs. In addition, the study took place in Massachusetts, which has a high rate of health insurance. Further, the researchers did not have information on participants who did not complete screening and did not have much information on the duration of diabetes and tobacco use.

“An intervention program that screens for unmet basic needs and attempts to link patients with these needs to community resources improved blood pressure and [LDL cholesterol] level but not HbA1c level,” the researchers wrote. “Further refinement of these types of interventions, and their dissemination, holds promise for improving the health of vulnerable populations.”