Enhanced Care Planning Study: Barriers to Successful Community Referrals for Patients with Multiple Chronic Conditions

Smith, G., O’Loughlin, K., Hinesley, J., Lail Kashiri, P.,

Webel, B., Brooks, E.M., Britz, J., Scheer, J., Krist, A.H.

Background:

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• Social needs, unhealthy behaviors, and mental health needs are important to overall health and common concerns among patients with chronic disease
• Primary care providers (PCPs) often refer patients to community resources to receive supportive services
• Chronic conditions can introduce difficulties in daily life and management can be complex
• There is limited research identifying barriers to accessing community resources for this population

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Objective:

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To describe the different barriers to accessing community resources for patients with multiple chronic conditions

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Methods:

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Study Population

• Twenty-two adult primary care patients with 2+ chronic conditions: cardiovascular disease hypertension, diabetes, hyperlipidemia, obesity, and depression

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Procedure

• This is a part of the ongoing Enhanced Care Planning (ECP) study, which will examine the effects of a care planning intervention on health outcomes of patients with MCC.
• Patients were included in the current analysis if they received community referral support as a part of the intervention
• A thematic analysis was completed on Community Health Worker notes

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Results:

• Patients frequently reported cost of a referral or unexpected life expenses as barriers to following through on referrals (Figure 1).
• The interference of work schedules and childcare were also commonly reported (Figure 2).
• Computer literacy as well as the method of relaying referral information also hindered referral connections (Figure 1).
• Patients reported both general stressors and health-related stress as barriers (Figure 3).
• Previous negative experiences with similar resources or preferred alternative resources also served as barriers (Figure 2).
• Health insurance and the capacity of the resource were among other reported barriers.

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Conclusions: Considering potential barriers and patient lifestyle prior to suggestions may enhance the success of primary care's community referrals.

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Department of Family Medicine & Population Health

Barriers

Expenses

Computer

Literacy

Relaying

Referrals

Patient

Stress

Perception of Resource

Preferences

Family & Work

Capacity of Resource

Health Insurance

Figure 1: Barriers to Successful Community Referrals

"[My blood sugar is] really high, and I'm trying to get it down. It's really overwhelming and so I can't really think of anything else right now”.

[Patient Stress]

"To be honest with you, I have not done a thing with [my referrals].. Summer hit hard with my eight grandkids”. -Patient [Family & Work]

Patient reported her PCP suggested a psychiatry referral, but patient indicated this was not a viable option for her due to her history with psychologists/psychiatrists where they 'did nothing to help me’.

[Perception of Resource]

Patient spoke with one private practice and determined that the therapists that were good fits were no longer taking new clients. [Capacity of Resource & Preferences]

“Patient inadvertently deleted my voicemail with dentist referral”

[Relaying Referrals]

Pt after deciding to work overtime to afford service:

“[The dentures] are quite expensive but I know I need the work done, and I like the dentist.”

[Expenses]

Figure 2: Patient and Study Team Quotes

Funding: AHRQ 1R01HS02622-01A1

Figure 3: Barriers with subthemes

• Expenses
• Overall cost
• Unexpected life expenses
• Health Insurance
• Capacity of Resource
• Patient Preferences
• Patient urgency for resource
• Patient time preferences and availability
• Perception of Resource
• Previous Negative Experience with a Resource
• Better Alternative Resource

Barriers

Expenses

Computer

Literacy

Relaying

Referrals

Patient

Stress

Perception of Resource

Preferences

Family & Work

Capacity of Resource

Health Insurance

• Computer Literacy
• Relaying Referral Information
• Family & Work Obligations
• Work schedule conflicts
• Family responsibilities
• Patient Stress
• General Stress
• Health Stress

Enhanced Care Planning Study: Barriers to Successful Community Referrals for Patients with Multiple Chronic Conditions

Smith, G., O’Loughlin, K., Hinesley, J., Lail Kashiri, P.,

Webel, B., Brooks, E.M., Britz, J., Scheer, J., Krist, A.H.

Background:

• Social needs, unhealthy behaviors, and mental health needs are important to overall health and common concerns among patients with chronic disease
• Primary care providers (PCPs) often refer patients to community resources to receive supportive services
• Chronic conditions can introduce difficulties in daily life and management can be complex
• There is limited research identifying barriers to accessing community resources for this population

​

Objective:

To describe the different barriers to accessing community resources for patients with multiple chronic conditions

​

Methods:

Study Population

• Twenty-two adult primary care patients with two or more of the following conditions: cardiovascular disease hypertension, diabetes, hyperlipidemia, obesity, and depression

Procedure

• This project is a part of the ongoing Enhanced Care Planning (ECP) study, which will examine the effects of a care planning intervention with community referral support on health outcomes of patients with MCC.
• Patients were included in the current analysis if they received community referrals
• A thematic analysis was completed on Community Health Worker notes

​

Funding: AHRQ 1R01HS02622-01A1

​

​

​

​

​

​

​

​

​

​

​

Results:

• Patients frequently reported cost of a referral or unexpected life expenses as barriers to following through on referrals.
• The interference of work schedules and childcare were also commonly reported.
• Computer literacy as well as the method of relaying referral information also hindered referral connections.
• Patients reported both general stressors and health-related stress as barriers.
• Previous negative experiences with similar resources or preferred alternative resources also served as barriers.
• Health insurance and the capacity of the resource were among other reported barriers.

​

Conclusions: Considering potential barriers and patient lifestyle prior to suggestions may enhance the success of primary care's community referrals.

​

​

Department of Family Medicine & Population Health

Barriers

Expenses

Computer

Literacy

Relaying

Referrals

Patient

Stress

Perception of Resource

Preferences

Family & Work

Capacity of Resource

Health Insurance

Figure 1: Barriers to Successful Community Referrals

"[My blood sugar is] really high, and I'm trying to get it down. It's really overwhelming and so I can't really think of anything else right now”.

"To be honest with you, I have not done a thing with [my referrals].. Summer hit hard with my 8 grandkids”.

“I haven’t rescheduled my appointment yet, because so much has been going on. I am babysitting for my daughter. My daughter and her husband are in the army service. I have also been working part time a bit”.

"Life is getting in the way”.

“A lot of things are coming at me right now”.

Pt after deciding to work overtime to afford service:

“[The dentures] are quite expensive but I know I need the work done, and I like the dentist.”

Figure 2: Patient and Study Team Quotes