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

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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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