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Since 2018, the Center for Health and Research Transformation (CHRT) has been surveying primary care physicians (PCPs) across Michigan about their experiences screening patients for health-related social needs and referring them to community-based resources for support. In this report, we examine how social needs screening and knowledge about where to refer patients has changed from before the pandemic (2018), to during the COVID-19 public health emergency (2021), to the post-pandemic period (2023).

The analysis highlights what PCPs see as the most significant barriers to screening patients for social needs and referring them for care in 2023 and makes recommendations regarding how to sustain and promote progress moving forward.

Trends in screening patients for social needs

Overall, the majority of PCPs reported routinely screening patients for social needs and having knowledge about where to refer patients for social support.

In 2023, there were small increases in the proportion of PCPs screening for 1) food insecurity, 2) housing needs, 3) transportation needs, and 4) domestic violence with roughly two-thirds reporting that they screened for these social needs.

At the same time, there has been a decline in screening for 1) ability to afford care, 2) social isolation, 3) employment status, and 4) health literacy. The most notable decline in screenings was for social isolation with only six in ten providers asking about this issue in 2023, compared to nearly two-thirds in 2021.

Although it is tempting to assume that social isolation is less of an issue now that we are beyond the worst of the pandemic, this is still a prominent issue among many populations—one that has an outsized impact on health—and an important issue to continue to address. Finally, PCPs were least likely to screen patients for social needs like unemployment or health literacy, with only half of providers routinely asking about these issues.

Trends in referring patients for social support

There was an increase in knowledge of where to refer patients for social needs between 2018 and 2021 among PCPs, but this plateaued in 2023. The largest gaps between screening and referral among PCPs were found when dealing with:

• Social isolation and loneliness (a 21 percent gap),
• Lack of health literacy (a 20 percent gap), and
• Concerns about affordability of care (a 20 percent gap).

In fact, where there was a decline in screening for certain social needs, there is also a corresponding decline in knowing where to refer for those same needs. While causality cannot be determined (i.e., did the lack of knowledge about where to refer result in less willingness to screen for that need or vice versa?), it is an important relationship that warrants further study.

Taken together, these findings could be an indication of what some have deemed the “moral injury” effect on physicians. This moral injury occurs as a negative mental health impact arising when PCPs ask patients to open up about their struggles with social needs but are unable to offer tangible help.

Barriers to screening patients for social needs with recommendations

Read on for information about the key barriers Michigan physicians say are keeping them from screening patients for social needs and referring them for care, as well as recommendations for policymakers, payers, and health systems interested in addressing health-related social needs through primary care.