Cited by 172Public Health and Social InequalitiesHealth disparities and outcomesPrimary Care and Health Outcomes

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Addressing Social Determinants of Health in a Clinic Setting: The WellRx Pilot in Albuquerque, New Mexico.

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Page-Reeves, J., Kaufman, W., Bleecker, M., Norris, J., McCalmont, K., Ianakieva, V., Ianakieva, D., Kaufman, A.·2016·The Journal of the American Board of Family Medicine

DOI 10.3122/jabfm.2016.03.150272

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Abstract

Although it is known that the social determinants of health have a larger influence on health outcomes than health care, there currently is no structured way for primary care providers to identify and address nonmedical social needs experienced by patients seen in a clinic setting. We developed and piloted WellRx, an 11-question instrument used to screen 3048 patients for social determinants in 3 family medicine clinics over a 90-day period. Results showed that 46% of patients screened positive for at least 1 area of social need, and 63% of those had multiple needs. Most of these needs were previously unknown to the clinicians. Medical assistants and community health workers then offered to connect patients with appropriate services and resources to address the identified needs. The WellRx pilot demonstrated that it is feasible for a clinic to implement such an assessment system, that the assessment can reveal important information, and that having information about patients' social needs improves provider ease of practice. Demonstrated feasibility and favorable outcomes led to institutionalization of the WellRx process at a university teaching hospital and influenced the state department of health to require managed care organizations to have community health workers available to care for Medicaid patients.

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Authors: Page-Reeves, J., Kaufman, W., Bleecker, M., Norris, J., McCalmont, K., Ianakieva, V., Ianakieva, D., & Kaufman, A.
Affiliations: University of New Mexico (US)
ORCID: Kaufman, A.
Venue: The Journal of the American Board of Family Medicine
Publisher: American Board of Family Medicine (ABFM)
Published: 2016-05-01
Volume: 29
Issue: 3
Pages: 414-418
ISSN: 1557-2625 (ISSN-L)
1558-7118
DOI: 10.3122/jabfm.2016.03.150272
OpenAlex: W2384838247
Cited by: 172
References: 10
Citations by year: 2026: 13 · 2025: 17 · 2024: 20 · 2023: 26 · 2022: 18 · 2021: 16 · 2020: 19 · 2019: 17 · 2018: 12 · 2017: 8 · 2016: 6
FWCI: 18.91
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: The Journal of the American Board of Family Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Health › Public Health and Social Inequalities
Social Sciences › Health › Health disparities and outcomes
Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
Keywords: social determinants of health, social needs screening, primary care, community health workers, medical assistants, Medicaid, managed care, feasibility, Albuquerque
MeSH terms: Community Health Workers, Family Practice, Feasibility Studies, Health Policy, Humans, Insurance, Health, Reimbursement, Medicaid, New Mexico, Pilot Projects, Primary Health Care, Surveys and Questionnaires, Referral and Consultation, Socioeconomic Factors, United States, Social Determinants of Health

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Addressing Social Determinants of Health in a Clinic Setting: The WellRx Pilot in Albuquerque, New Mexico.

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