Healthcare providers consistently seek new and innovative ways to provide preventative care. Various screening methods during primary care visits identify an individual's risk of chronic illnesses before they develop them. For example, patients are screened for high blood pressure in the hopes of identifying and treating hypertension to lower their risk of cardiovascular disease in the future.1 In recent years, research has shown that screening for social factors, called social determinants of health (SDOH), can further improve doctors' ability to identify at-risk individuals.
Upwards of 70% of health outcomes are driven by factors beyond health care, and poverty alone is associated with more years of lost life than factors like smoking and obesity.2 People whose social and economic needs are unmet face barriers in all directions, preventing them from getting the care they need from the healthcare system. Given that most primary care visits have a median duration of 15.7 minutes, it is very likely for a provider to overlook the predictive factor of social and economic hardship for a patient's future health if it is not actively screened for during healthcare visits.3 Leading health agencies have identified the SDOH to try to improve the healthcare system for its most vulnerable.
The World Health Organization defines SDOH as the conditions in which people are born, grow, work, live, and age, as well as the broader set of forces and systems shaping the conditions of daily life. These include but are not limited to economic policies, social norms, and political systems.4 SDOH are organized into six groups: food security, economic stability, education, neighborhood and physical environment, community and social context, and the healthcare system.5
"Very often, when people talk about the social determinants of health and healthcare, what they are talking about are social needs of the individual."6
-Cindy Brach, a senior healthcare researcher at the Agency for Healthcare Research and Quality
Once a patient is screened, healthcare providers can respond according to the identified needs, usually by linking them to community resources or rethinking their treatment plan.7 For example, for a patient without steady employment, a nurse could provide resources for local job agencies or other related opportunities available in the area. This version of preventative medicine provides whole-person care, bettering patients' lives both medically and personally.
The SDOH approach is an evolving practice. Although considerable research has identified SDOH and the mechanisms that explain their impact, the best methods of integrating health services with community and social services have yet to develop fully.8 As this approach becomes more widespread, healthcare providers will better understand what practices help high-risk patients. The future of cutting-edge primary care relies on communities working together to create a support network, starting with a screening at the doctor's office and resulting in an impactful response to the patient's social needs.
Sources:
1. Jill Jin. “Screening for Hypertension in Adults.” Journal of the American Medical Association 325, no. 16 (April 2021): 1688. https://doi.org/10.1001/jama.2021.5288
2. Loel S Solomon and Michael H Kanter. “Health Care Steps Up to Social Determinants of Health: Current Context.” The Permanente Journal 22, no. 4S (October 2018): 18-139. https://doi.org/10.7812/TPP/18-139
3. Ming Tai-Seale, Thomas G McGuire, and Weimin Zhang. “Time Allocation in Primary Care Office Visits.” Health Services Research 42, no. 5 (October 2007): 1871-1894.https://doi.org/10.1111/j.1475-6773.2006.00689.x
4. Melissa Wirkus Hagstrom. “Screening for Social Determinants of Health: How Nurses Can Dig Deeper.” AMN Healthcare, 26 September 2020. https://www.amnhealthcare.com/blog/nursing/travel/screening-for-social-determinants-of-health/
5. “Social Determinants of Health.” Duke University Social Science Research Institute. https://ssri.duke.edu/social-determinants-of-health/
6. Hagstrom, “Screening for Social Determinants.”
7. Hagstrom, “Screening for Social Determinants.”
8. “Social Determinants of Health.”
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