BACKGROUND Poverty is associated with increased morbidity related to multiple child and adult health conditions and increased risk of premature death. Despite robust evidence linking income and health, and some recommendations for universal screening, poverty screening is not routinely conducted in clinical care. METHODS We conducted an exploratory study of implementing universal poverty screening and intervention in family medicine and a range of pediatric care settings (primary through tertiary). After attending a training session, health care providers (HCPs) were instructed to perform universal screening using a clinical poverty tool with the question "Do you ever have difficulty making ends meet at the end of the month?" for the three-month implementation period. HCPs tracked the number of patients screened and a convenience sample of their patients were surveyed regarding the acceptability of being screened for poverty in a healthcare setting. HCPs participated in semi-structured focus groups to explore barriers to and facilitators of universal implementation of the tool. RESULTS Twenty-two HCPs (10 pediatricians, 9 family physicians, 3 nurse practitioners) participated and 150 patients completed surveys. Eighteen HCPs participated in focus groups. Despite the self-described motivation of the HCPs, screening rates were low (9% according to self-reported numbers). The majority of patients either supported (72%) or were neutral (22%) about the appropriateness of HCPs screening for and intervening on poverty. HCPs viewed poverty as relevant to clinical care but identified time constraints, physician discomfort, lack of expertise and habitual factors as barriers to implementation of universal screening. CONCLUSIONS Poverty screening is important and acceptable to clinicians and patients. However, multiple barriers need to be addressed to allow for successful implementation of poverty screening and intervention in health care settings.

中文翻译：

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在各种家庭医学和儿科护理环境中对临床贫困工具的“现实世界”实施进行的探索性研究。

背景技术贫困与与多种儿童和成人健康状况有关的发病率增加以及过早死亡的风险增加有关。尽管有可靠的证据表明收入和健康之间存在联系，并提出了一些普遍筛查的建议，但在临床护理中并未常规进行贫困筛查。方法我们进行了一项探索性研究，以期在家庭医学和一系列儿科护理环境中（从初级到三级）实施普遍贫困筛查和干预。参加培训课程后，医疗保健提供者（HCP）被指示使用临床贫困工具进行普遍筛查，并提出以下问题：“您在月底时是否难以维持生计？” 为三个月的实施期。HCP跟踪了接受筛查的患者数量，并就其患者在医疗机构中接受贫困筛查的可接受性进行了便利性抽样调查。HCP参加了半结构化焦点小组，以探讨该工具普遍实施的障碍和促进者。结果22位HCP（10位儿科医生，9位家庭医生，3位护理从业人员）参加了调查，并有150位患者完成了调查。18个HCP参加了焦点小组。尽管有HCP自我描述的动机，但筛查率仍然很低（根据自我报告的数字为9％）。大多数患者对HCP筛查和干预贫困的适当性表示支持（72％）或中立（22％）。卫生保健工作者认为贫困与临床护理有关，但确定了时间限制，医师的不适，缺乏专业知识和习惯性因素阻碍了实施普查。结论贫困筛查是重要的，临床医生和患者都可以接受。但是，需要解决多个障碍，才能成功实施贫困筛查和在医疗机构中进行干预。