title: Social barriers to listing for adult liver transplantation: their prevalence and association with program characteristics.
abstract: Social barriers to effective medical care are mandated to be routinely assessed as part of an evaluation for liver transplantation. This study explores how frequently liver transplant programs encounter these barriers in patients undergoing an evaluation and whether programs with higher proportions of Medicaid patients, historically disadvantaged minority patients, and rural patients encounter social barriers more frequently. A survey for assessing patient demographics and social barriers was electronically completed by representatives of 61 of 104 eligible US adult liver transplant programs (59%). Fifty-eight of the 61 programs identified themselves, and their characteristics were similar to those of all 104 US programs according to publicly available data from the Organ Procurement and Transplantation Network. Social barriers were reported to be encountered sometimes (10%-30%) or frequently (>30%) by the 61 programs as follows: inadequate or unstable health insurance (68.9% of the programs), a chaotic social environment (63.9%), a lack of a care partner (60.7%), an inability to obtain transportation (49.2%), a low educational level (36.1%), inadequate housing (23.0%), a language barrier (19.7%), no reliable way of contacting the patient (16.4%), difficulty in obtaining child care (11.5%), and food insecurity (8.2%). The frequencies of perceived social barriers did not differ significantly between programs reporting higher or lower proportions of Medicaid, minority, or rural patients. Our analysis suggests that program-level operational planning for addressing social barriers to transplant listing should be considered regardless of the proportions of Medicaid-insured, racial or ethnic minority, and rural patients in the population.
authors.affiliation: Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY 10467, USA. aflattau@montefiore.org
authors.forename: Anna
authors.initials: A
authors.lastname: Flattau
authors.forename: Manhal
authors.initials: M
authors.lastname: Olaywi
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Gaglio
authors.forename: Paula
authors.initials: P
authors.lastname: Marcus
authors.forename: Paul
authors.initials: P
authors.lastname: Meissner
authors.forename: Emily B
authors.initials: EB
authors.lastname: L Dorfman
authors.forename: John F
authors.initials: JF
authors.lastname: Reinus
mesh_terms: D000328:Adult; D002648:Child; D002654:Child Care / Q000706:statistics & numerical data; D002675:Child, Preschool; D003144:Communication Barriers; D004522:Educational Status; D005523:Food Supply / Q000706:statistics & numerical data; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006798:Housing / Q000706:statistics & numerical data; D006801:Humans; D007802:Language; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D017533:Marital Status / Q000706:statistics & numerical data; D008484:Medicaid / Q000706:statistics & numerical data*; D008913:Minority Groups / Q000706:statistics & numerical data*; D016730:Program Development; D012424:Rural Population / Q000706:statistics & numerical data*; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data; D014186:Transportation / Q000706:statistics & numerical data; D014481:United States; D035862:Vulnerable Populations / Q000706:statistics & numerical data*; D014850:Waiting Lists