Aim Having reaffirmed the centrality of Primary Health Care to achieving universal health coverage, WHO member states now must operationalize their commitments. Leveraging primary care systems to assess and address the social determinants of health (SDOH) is a sensible starting point, however best practices remain unclear. We examined how primary care organizations assess and subsequently act upon the social determinants of non-communicable diseases (NCDs) and sought to compare actions stemming from routine versus ad-hoc SDOH assessments.

Methods PubMed, MEDLINE, Embase and HMIC were searched from inception to 28th June 2019, along with hand-searching of references. Studies of any design that examined a primary care organization assessing social determinants of NCDs with the intention of subsequently intervening upon them were included. We excluded papers with the following characteristics: solely described theoretical models or organizational plans; described single-issue initiatives for narrow sub-populations and; stand-alone epidemiological surveys unless conducted with intention of assessing local SDOH. Independent dual review was used for screening, data extraction, and quality assessment. For quality assessment, modified Cochrane risk of bias and Newcastle-Ottawa tools were used.

Results Searches identified 666 studies of which 17 were included. All used descriptive study designs. Individual-level surveys and interviews were the most common approaches reported. Fewer studies involved the collation of secondary population-level data held by agencies external to the primary care organization. Numerous actions were described, ranging from individual-level interventions such as social service referrals to novel representation of primary care organizations on system-level policy and planning committees. No inferences could be made about whether routine SDOH assessments were more or less likely to result in action than ad-hoc assessments. Several enablers and barriers to collecting and mobilizing SDOH data within well- and under-resourced primary care settings were identified.

Conclusion Worldwide, primary care systems are increasingly being asked to engage with social determinants of health. The studies included in our review provide a number of different potential approaches for this task.

Our review identified several primary care approaches to leveraging patient- and population-level data to identify and initiate action on social determinants of NCDs. Stronger evaluative and experimental studies are needed to understand if primary care based SDOH data collection leads to actions that mitigate unmet health and social needs.