PT  - JOURNAL ARTICLE
AU  - Seth A Berkowitz
AU  - A Catherine Hulberg
AU  - Clemens Hong
AU  - Brian J Stowell
AU  - Karen J Tirozzi
AU  - Carine Y Traore
AU  - Steven J Atlas
TI  - Addressing basic resource needs to improve primary care quality: a community collaboration programme
AID  - 10.1136/bmjqs-2015-004521
DP  - 2016 Mar 01
TA  - BMJ Quality & Safety
PG  - 164--172
VI  - 25
IP  - 3
4099  - http://qualitysafety.bmj.com/content/25/3/164.short
4100  - http://qualitysafety.bmj.com/content/25/3/164.full
SO  - BMJ Qual Saf2016 Mar 01; 25
AB  - Background Unmet basic resource needs, such as difficulty affording healthcare, medications, food and housing, may contribute to worse healthcare quality indicators, but interventions are hampered by lack of specific knowledge regarding the distribution of unmet basic resource needs and their association with priority clinical conditions and health service use patterns.Methods Cross-sectional study of primary care patients in two urban academic practices from 1 October 2013 to 30 April 2014. Patients were screened for unmet needs and enrolled in a programme to link them with community resources. Key measures included patient report of unmet basic resource needs, clinical conditions prioritised by quality improvement programmes (hypertension, diabetes and depression), and health service use patterns such as frequent emergency department (ED) visits (>2 in the preceding year) and frequent clinic ‘no-shows’ (>1 in the preceding year).Results 416 patients with unmet needs were included, and compared with 2750 patients who did not report needs. The most common types of needs reported were: difficulties affording healthcare (46.5%), food (40.1%) and utilities (36.3%). Patients who reported unmet needs were more likely to have depression (17.8% vs 9.5%, p<0.0001), diabetes (32.7% vs 20.4%, p<0.0001), hypertension (54.3% vs 46.3%, p=0.002), be frequent ED users (11.3% vs 5.4%, p<0.0001), and have frequent ‘no-shows’ to clinic (21.6% vs 11.9%, p<0.0001).Conclusions Difficulty affording healthcare and food are particularly common needs among patients with priority conditions. Strategies to identify and address unmet needs as part of routine care may be an important way to improve healthcare quality.