Seeing the unseen: uncovering health-related social needs through universal screening at an academic ophthalmology practice

Abstract

Health-related social needs (HRSN), or unmet conditions that are important to maintain health (such as finances and transportation), contribute to vision health disparities. The purpose of this study is to identify the unmet HRSN of ophthalmology clinic patients. This retrospective, cross-sectional study examined HRSN survey results from adult patients who checked in for a clinic visit at a tertiary academic eye centre from April 28, 2022, to March 31, 2023. Demographics and visual acuity were extracted from the electronic health record, and their reported HRSNs were evaluated using binary logistic regression. Of 1413 patients who completed the survey, 194 (13.7%) screened positive for at least one HRSN. The most frequently reported need was food insecurity (99/1303, 7.6%), followed by transportation (68/1340, 5.1%), housing instability (63/1305, 4.8%), financial insecurity (46/1293, 3.6%), and homelessness (10/1330, 0.8%). Patients with at least one reported HRSN were more likely to be Black compared to White (OR 4.03, 95% CI: 2.71–5.96), female compared to male (OR 1.88, 95% CI: 1.34–2.62), and younger than 65 years of age compared to 65 to 75 years (OR 2.35, 95% CI: 1.68–3.37) or older than 75 years (OR 4.62, 95% CI: 2.54–8.16). Presence of at least one HRSN was associated with visual impairment, with greater odds of best-corrected visual acuity worse than 20/40 in the group with HRSN compared to without HRSN (OR 1.55, 95% CI: 1.09–2.19). Integrating a screening questionnaire in ophthalmology clinics can uncover unaddressed HRSN, enabling resource allocation to mitigate vision health disparities.