title: Content and Outcomes of Social Work Consultation for Patients with Diabetes in Primary Care.
abstract: Social workers are positioned to address social determinants of health (SDHs), but their specific roles in outpatient primary care practice have not been well described. We aimed to describe needs of patients with diabetes addressed during social work (SW) consultations and their impact on disease control.
  
  
  
  This study was a retrospective review of electronic medical records of 977 patients with diabetes with a SW consultation at 3 primary care internal medicine sites in 2014. Diabetes and cardiovascular (CV) risk factor control were assessed before and after the SW encounter. Patient subgroups with uncontrolled diabetes or CV risk factors were compared with propensity-matched patients without a SW encounter. Of the 977 records, 300 were randomly selected for abstraction of needs addressed at the SW consultation using SDH categories established by Wilkinson and Marmot.
  
  
  
  Patient insurance status included 52% Medicare and 32% Medicaid. The SDHs most often addressed were social gradient (67%; obtaining medications or health insurance) and social support (25%). Among our total population, there were no significant improvements in glycosylated hemoglobin (HbA1c), low-density lipoprotein (LDL) cholesterol, systolic blood pressure, or body mass index at least 3 months after the first SW consultation. For patients with uncontrolled diabetes (HbA1c>9% or LDL cholesterol >130 mg/dl), HbA1cimproved by 1.5 versus 1.1% for matched controls (P = .03) and LDL improved by 37.7 versus 21.3 mg/dl for matched controls (P = .002).
  
  
  
  In this sample with a preponderance of Medicare and Medicaid patients, social workers most often assisted patients with diabetes in obtaining medications or health insurance. For patients with uncontrolled diabetes or cholesterol, a temporal association between SW consultation and improved disease control was noted.
authors.affiliation: From the Case Western Reserve University School of Medicine, Cleveland, OH (AJR); the Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland (MBR, ADM-H); the Department of Bioethics, Cleveland Clinic, Cleveland (SLR); the Department of Internal Medicine, Cleveland Clinic, Cleveland (AB); the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland (LK, ADM-H); and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (MBR, SLR, AB, ADM-H).
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Rabovsky
authors.affiliation: From the Case Western Reserve University School of Medicine, Cleveland, OH (AJR); the Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland (MBR, ADM-H); the Department of Bioethics, Cleveland Clinic, Cleveland (SLR); the Department of Internal Medicine, Cleveland Clinic, Cleveland (AB); the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland (LK, ADM-H); and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (MBR, SLR, AB, ADM-H).
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
authors.affiliation: From the Case Western Reserve University School of Medicine, Cleveland, OH (AJR); the Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland (MBR, ADM-H); the Department of Bioethics, Cleveland Clinic, Cleveland (SLR); the Department of Internal Medicine, Cleveland Clinic, Cleveland (AB); the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland (LK, ADM-H); and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (MBR, SLR, AB, ADM-H).
authors.forename: Susannah L
authors.initials: SL
authors.lastname: Rose
authors.affiliation: From the Case Western Reserve University School of Medicine, Cleveland, OH (AJR); the Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland (MBR, ADM-H); the Department of Bioethics, Cleveland Clinic, Cleveland (SLR); the Department of Internal Medicine, Cleveland Clinic, Cleveland (AB); the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland (LK, ADM-H); and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (MBR, SLR, AB, ADM-H).
authors.forename: Andrei
authors.initials: A
authors.lastname: Brateanu
authors.affiliation: From the Case Western Reserve University School of Medicine, Cleveland, OH (AJR); the Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland (MBR, ADM-H); the Department of Bioethics, Cleveland Clinic, Cleveland (SLR); the Department of Internal Medicine, Cleveland Clinic, Cleveland (AB); the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland (LK, ADM-H); and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (MBR, SLR, AB, ADM-H).
authors.forename: Lei
authors.initials: L
authors.lastname: Kou
authors.affiliation: From the Case Western Reserve University School of Medicine, Cleveland, OH (AJR); the Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland (MBR, ADM-H); the Department of Bioethics, Cleveland Clinic, Cleveland (SLR); the Department of Internal Medicine, Cleveland Clinic, Cleveland (AB); the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland (LK, ADM-H); and the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland (MBR, SLR, AB, ADM-H). misraa@ccf.org.
authors.forename: Anita D
authors.initials: AD
authors.lastname: Misra-Hebert
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000379:methods*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000191:economics / Q000628:therapy*; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000191:economics / Q000628:therapy*; D057286:Electronic Health Records; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006301:Health Services Needs and Demand; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012947:Social Work / Q000379:methods*; D014481:United States
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin
keywords: Ambulatory Care; Blood Pressure; Body Mass Index; Cholesterol; Diabetes Mellitus; Electronic Health Records; Glycosylated; Health Insurance; Hemoglobin A; LDL; Outpatients; Primary Health Care; Referral and Consultation; Retrospective Studies; Risk Factors; Social Determinants of Health; Social Support; Social Work; Social Workers