Implementation of Social Needs Screening and Intervention in Primary Care : A Systematic Review of Program-Level Determinants.

Abstract

Health care systems are investing significant resources in social needs screening and intervention programs. To understand characteristics contributing to implementation of social needs screening and intervention programs in primary care. CINAHL, Cochrane, Ovid, PubMed, and Scopus (January 2015 to April 2025). U.S.-based programs using structured tools to screen adult patients for at least 1 Healthcare Effectiveness Data and Information Set measure (food insecurity, transportation, and housing insecurity) and addressing social needs in primary care settings. Program characteristics; screening and intervention implementation processes; and patient screening, intervention, clinical, and health care use outcomes. The review included 23 studies. Seventeen reported on screening outcomes, 11 in populations characterized by a particular condition or health care use and 6 in the general population. Programs with the highest percentage of patients screened focused on fewer than 500 patients with a particular condition or health care use and received support from additional staff or volunteers (4 of 17 studies). Of patients screened, 10.1% to 100% reported a social need. Eleven studies reported on receipt of assistance or resources, with a higher percentage of patients receiving assistance or resources among programs that targeted a smaller population. Few studies reported clinical and health care use outcomes, with mixed findings. Few studies had complete reporting of screening and intervention rates and outcomes. Program characteristics and other screening and intervention processes varied across and within studies. Social needs programs focused on smaller, targeted populations were more likely to screen and assist a higher percentage of patients. Programs with adequate staffing may also screen a higher proportion of patients. However, evidence is mixed, particularly for clinical and health care use outcomes. Considerable differences among screening and intervention programs preclude simple suggestions for universal implementation. Live Well Intramural Pilot Grant Program. (PROSPERO: CRD42023431151).