P2.082: The Proverbial “What do you do?”: An Evaluation of FQHC Pediatrician Perspective on Drivers of Health Screening

Background: A 2022 study found that approximately 70% of Federally Qualified Health Centers (FQHCs) have social risk-screening capabilities. Children living in households with low socioeconomic status and with health-related social needs have worse health outcomes. Pediatricians in FQHCs experience the confluence of these findings. This exploratory study uses qualitative techniques to capture the views of front-line, community pediatricians working in FQHCs participating in drivers of health (DOH) screening and provides insight on improving screening practices, building response systems, and affecting physician morale.

Project Description: Qualitative methods using a constructivist grounded theory approach were used to explore pediatric clinicians’ perspectives, practices, and patterns of screening for DOH for their patients within FQHCs across the United States. Pediatricians working in FQHCs were recruited and interviewed. Interview transcripts were reviewed, themes and subthemes were identified, a coding framework was developed, and disputes were resolved by a designated content expert. The codebook was edited to clarify emerging themes and subthemes. Importantly, the prompts about screening in these interviews immediately led to robust discussions of ideal and non-ideal systems for responding to patient needs. In our sample, pediatricians quickly moved from the logistics of screening to discussing implementation practices. This approach captured the complexities in clinicians’ perspectives and can inform the development of frameworks regarding barriers, facilitators, and current practices for systems of DOH screening and response.

Discussion: Based on these interviews of pediatricians in FQHCs across the United States, three general themes emerged:
1) Support for drivers of health screening and response systems. Subthemes included: a) Dedicated staffing models, b) Access to community resources, c) Co-location of services, d) Stable organizational funding.
2) Barriers to successful screening for drivers of health. Subthemes included: a) Perception of time related to screening fatigue and care prioritization, b) Language barriers, c) Availability of resources.
3) FQHC pediatrician personal importance and impact of screening for drivers of health’ themes. Subthemes included: a) Recognizing social need importance, b) Responsibility for health and well being, c) Moral distress, d) Physician burnout.
Limitations of this study included a small sample size of seven participants despite a large recruitment effort.

Conclusion: The aim of this study was not to determine the best method of screening for DOH, but to identify perspectives of front-line physicians in FQHCs. The FQHC pediatricians interviewed explained how screening and response systems can be improved. The pediatricians recognized the importance of screening patients for DOH. The perception of screening success was shaped by the support or barriers felt in the clinic or in their respective state. Using dedicated staffing models and stable funding alleviates some of the stressors that can lead to moral distress and burnout. Future efforts should target interprofessional team development, advocacy skills training, and health policy changes.