Psychosocial Problems in Primary Care: Patient and Provider Perceptions

Abstract

Primary care physicians and clinics have become the frontline of health care for most Americans—they are the first point of contact and the source of both treatment and referrals. Psychosocial problems, such as difficulty with finances, family, housing, and work, are associated with a high demand for medical care in primary care practice, yet little is known about the prevalence of psychosocial problems in primary care settings. The purpose of this study is to assess the type and level of psychosocial problems in primary care patients by examining patient and provider perceptions at the Veterans Affairs Greater Los Angeles Healthcare System (VAGLAHS). A purposive sample of 684 veterans and a convenience sample of 59 providers anonymously completed the Social Needs Checklist. Patients reported an average of five psychosocial problems, with finances, personal stress, transportation, employment, and legal issues being the most prevalent. Thirty-two percent of patients indicated a desire to see a social worker. Provider and patient differences were compared. Provider estimates of patients' problems were consistently lower than patient estimates in all psychosocial problem areas except need for nursing home placement and problem drinking or drug use. Implications for social work in primary care are discussed.

KEYWORDS:

• primary care
• psychosocial problems
• patient and provider perceptions

The authors thank A. E. Benjamin, M. Belinda Tucker, and anonymous reviewers for their helpful feedback on this article. We acknowledge the Department of Veterans Affairs, veterans, and VA healthcare providers for their participation and service.