Medicine has already begun transitioning to achieve the goal of making healthcare more affordable and improving the quality of care for everyone. Unfortunately, social factors are powerful determinants of health. Professionals must be trained on what truly impacts health and the available tools to combat social economic inequities.
There are three basic principles of healthcare reform:
- Access to clinical outcomes
- Patient-centered care
- Coordination of care
WHAT IS “PATIENT-CENTERED CARE”?
The goal of this article is to focus on patient-centered care, which is collaborative and coordinated, going beyond physical well-being to also include the emotional, social and financial aspects of a patient’s situation.
An essential component of patient-centered care is social determinants of health (SDOH). Social risk factors are also referred to as “health-related social needs” or “social influences.” These are the non-medical factors that influence health outcomes. These forces include economic policies, social norms, social policies, racism, climate change and political systems. Everyone should have fair and just access to equitable healthcare.
On a national policy level, this requires removing obstacles to health, such as poverty, discrimination and their consequences, which include powerlessness, lack of access to good jobs with fair pay, quality education and housing, safe environments and healthcare.
At the clinical level, if you understand the challenges patients face in following their physician’s recommended treatment plan, you can help them overcome these obstacles. This is referred to as “patient-centered care” under healthcare reform.
Example of Social Determinants of Health
- Income and social protection
- Education
- Unemployment and job insecurity
- Working life conditions
- Food insecurity
- Housing, basic amenities and the environment
SDOH are not experienced equally by all people and are often linked to each other. For example, education and access to transportation can impact employment opportunities, and one’s neighborhood location can impact access to healthy food options. Perhaps the most powerful SDOH is income. Many of your patients cannot afford their medications, a healthy diet or a proper place to live, which strongly influences their health and longevity.
One of the authors of this article was recently scheduled for an annual physical from his primary care provider (PCP). Several days prior to his appointment, he received an e-mail from his PCP which instructed him to logon to the patient portal to complete a questionnaire.
After logging in, there were questions about patient history, a payer questionnaire and a communicable disease screening. SDOH-related questions are increasingly being asked along with the usual patient histories, vital signs, lab results and medication orders.
Examples of “Social Influences” Questions
The patient would be asked to mark “yes” or “no,” or to provide a rating as to how much they agree, with the following statements:
- Within the past 12 months we worried whether our food would run out before we got money to buy more
- Within the past 12 months the food that we bought didn’t last and we didn’t have money to get more
- How hard is it for you to pay for basic food, housing, medical care and air conditioning and heating?
- Are you worried that in the next two months you may not have stable housing?
- Do you have access to a variety of food including fruits and vegetables?
- Within the last three months, how many times did you visit the emergency department for your medical care?
- Has the lack of transportation kept you from meetings, work or from getting things needed for daily living?
- Has the lack of transportation kept you from medical appointments or from getting medications?
- How often do you feel lonely or isolated from those around you?
- How often do you need to have someone help you when you read instructions, pamphlets or other written material from your doctor or pharmacy?
- If you checked YES (or marked a numbered ranking higher than X) to any of the above questions, would you like to receive assistance with any of these needs?
Looking Toward the Future
Healthcare is transitioning to address these issues, which are now considered to be an essential part of delivering quality care.
In the near future, Healthcare Registries will be adding a link to its website where you will be able to find a list of community and government services in your zip code to assist your patients with their needs.
