Abstracts

Rationale: The World Health Organization defines Social Determinants of Health (SDOH) as the non-medical factors that influence health outcomes. Health outcomes are related to SDOH 30-55% of the time as health and illness follow the social gradient. A total of 20% of the US population lives in rural areas with limited access to transportation and high-quality healthcare. Food insecurity was reported in up to 25% of US households during and post-pandemic times. More than one in five people could not access healthcare due to lack of transportation, with blacks, disabled adults, and those of low income being impacted the most. Missed medical appointments cost the United States healthcare system $150 billion annually.

Methods: Georgia has the 3rd highest rate of uninsured population at 13.7%, with Black (36%) and Latinos (22%) being most affected. Grady Memorial Hospital in Atlanta is one of the largest safety net hospitals in Georgia offering care to the vulnerable populations. Multiple outpatient services are provided by the Grady system, including Neuroscience, primary care, geriatrics, cancer care, diabetes, surgery etc. Patients seen at Grady are screened for SDOH during clinic visits and are provided with resources to address the barriers identified.

Results: Overall, 73905 patients were seen and screened for SDOH in the Grady outpatient setting during October 2022 to April 2023. Of these, 5127 patients were seen in the Grady Neuroscience Center and 304 patients in the Grady epilepsy clinic. The four main criteria used for assessing SDOH were financial resources, food insecurity, transportation and housing. A total of 55.7% of patients screened reported financial strain (50.4% Neuroscience); 60.5% reported worry about food insecurity (58.8% Neuroscience) and 60.4% reported inability to access food. A total of 188 (61.8%) patients seen in the epilepsy clinic were screened for financial resource strain and 76 (40.4%) were found positive. A total of 223 (73.4%) patients were screened for food insecurity: 71 (31.8%) patients reported worrying about food whereas 68 (30.5%) indicated inability to access food. A total of 211 (69.4%) were screened for transportation issues: 44 (20.9%) indicated it as a barrier to care. A total of 206 (67.8%) patients were screened for housing: 26 (8.6%) patients reported living in shelters while 48 (15.8%) reported housing cost as a barrier. Of the 881 patients seen in the Geriatric clinic, 94.6% of patients reported food insecurity, 94.6% housing issues, 94.9% reported transportation as a barrier and 94.4% reported financial strain.

Conclusions: More than half of the patient population at Georgia’s largest safety-net hospital identified significant social barriers to health. Food instability, transportation, financial strain and housing were the overall limiting factors with the older population at significantly higher risk. Financial strain, followed by food insecurity, transportation and housing were identified as barriers by patients with epilepsy. Health disparities are preventable, and recognizing the barriers is the first step in improving care for these vulnerable populations.

Funding: None