scholarly journals INTEGRATING SOCIAL DETERMINANTS OF HEALTH IN CLINICAL CARE DELIVERY

2020 ◽  
Vol 75 (11) ◽  
pp. 801
Author(s):  
Anekwe E. Onwuanyi ◽  
Diane Wirth ◽  
Faith Works-Fleming ◽  
Andrea Cafarelli ◽  
Michael Knauss ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Care Delivery ◽  
Clinical Care ◽  
Determinants Of Health

scholarly journals Integrating Social Determinants of Health and Laboratory Data: A Pilot Study To Evaluate Co-Use of Opioids and Benzodiazepines

2019 ◽  
Vol 6 ◽  
pp. 237428951988487 ◽  
Author(s):  
Jill S. Warrington ◽  
Nick Lovejoy ◽  
Jamie Brandon ◽  
Keith Lavoie ◽  
Chris Powell
Keyword(s):  
Pilot Study ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Clinical Care ◽  
Laboratory Finding ◽  
Laboratory Data ◽  
Determinants Of Health ◽  
Opioid Use ◽  
Opioid Crisis ◽  
Increased Risk

As the opioid crisis continues to have devastating consequences for our communities, families, and patients, innovative approaches are necessary to augment clinical care and the management of patients with opioid use disorders. As stewards of health analytic data, laboratories are uniquely poised to approach the opioid crisis differently. With this pilot study, we aimed to bridge laboratory data with social determinants of health data, which are known to influence morbidity and mortality of patients with substance use disorders. For the purpose of this pilot study, we focused on the co-use of opioids and benzodiazepines, which can lead to an increased risk of fatal opioid-related overdoses and increased utilization of acute care. Using the laboratory finding of the copresence of benzodiazepines and opioids as the primary outcome measure, we examined social determinants of health attributes that predict co-use. We found that the provider practice that ordered the laboratory result is the primary predictor of co-use. Increasing age was also predictive of co-use. Further, co-use is highly prevalent in specific geographic areas or “hotspots.” The prominent geographic distribution of co-use suggests that targeted educational initiatives may benefit the communities in which co-use is prevalent. This study exemplifies the Clinical Lab 2.0 approach by leveraging laboratory data to gain insights into the overall health of the patient.

scholarly journals Number of Social Determinants of Health and Fatal and Nonfatal Incident Coronary Heart Disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽  
2020 ◽  
Author(s):  
Monika M. Safford ◽  
Evgeniya Reshetnyak ◽  
Madeline R. Sterling ◽  
Joshua S. Richman ◽  
Paul M. Muntner ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Social Determinants Of Health ◽  
Racial Differences ◽  
Social Determinants ◽  
Clinical Care ◽  
Community Dwelling ◽  
Determinants Of Health ◽  
Incident Coronary Heart Disease ◽  
Prospective Longitudinal

Background: Social determinants of health (SDH) are individually associated with incident coronary heart disease (CHD) events. Indices reflecting social deprivation have been developed for population management, but are difficult to operationalize during clinical care. We examined whether a simple count of SDH is associated with fatal incident CHD and nonfatal myocardial infarction (MI). Methods: We used data from the prospective longitudinal REasons for Geographic And Racial Differences in Stroke cohort study, a national population-based sample of community-dwelling Black and white adults age ≥45 years recruited from 2003-7. Seven SDH from the five Healthy People 2020 domains included social context (Black race, social isolation); education (educational attainment); economic stability (annual household income); neighborhood (living in a zip code with high poverty); and healthcare (lacking health insurance, living in one of the 9 US states with the least public health infrastructure). Outcomes were expert adjudicated fatal incident CHD and nonfatal MI. Results: Of 22,152 participants free of CHD at baseline, 58.8% were women, 42.0% were Blacks, 20.6% had no SDH, 30.6% had 1, 23.0% had 2, and 25.8% had ≥3. There were 463 fatal incident CHD events and 932 nonfatal MIs over median 10.7 years [IQR 6.6-12.7]. Fewer SDH were associated with nonfatal MI than with fatal incident CHD. The age-adjusted incidence per 1000 person-years increased with the number of SDH for both fatal incident CHD (0 SDH 1.30, 1 SDH 1.44, 2 SDH 2.05, ≥3 SDH 2.86) and nonfatal MI (0 SDH 3.91, 1 SDH 4.33, ≥2 SDH 5.44). Compared to those without SDH, crude and fully adjusted hazard ratios (HR) for fatal incident CHD among those with ≥3 SDH were 3.00 (95% CI 2.17, 4.15) and 1.67 (95% CI 1.18, 2.37), respectively; and that for nonfatal MI among those with ≥2 SDH were 1.57 (95% CI 1.30, 1.90) and 1.14 (0.93, 1.41), respectively. Conclusions: A greater burden of SDH was associated with a graded increase in risk of incident CHD, with greater magnitude and independent associations for fatal incident CHD. Counting the number of SDH may be a promising approach that could be incorporated into clinical care to identify individuals at high risk of CHD.

scholarly journals Using Social Determinants Screening/Mapping Tools to Identify Needs and Resources for Student-Run Free Clinic Patients

2021 ◽  
Vol 4 (1) ◽  
pp. 38-44
Author(s):  
Akanksha Dadlani ◽  
Cooper T. Johnson ◽  
Rebecca Fischbein ◽  
Stacey L. Gardner-Buckshaw ◽  
Amy Lee ◽  
...  
Keyword(s):  
Health Care ◽  
Social Determinants Of Health ◽  
Health Care Delivery ◽  
Social Determinants ◽  
Care Delivery ◽  
Health Screening ◽  
Determinants Of Health ◽  
Free Clinic ◽  
Community Resource ◽  
Patient Reported

Background: Social determinants of health have been well accepted as contributing to health outcomes. They are a vital aspect of health care delivery and must be a consideration, especially among free clinic populations. Social determinants of health have also become a required element of medical school curricula. The Student Outreach to Area Residents Student-Run Free Clinic based out of Northeast Ohio Medical University piloted a student-led program that implemented social determinants of health screening and community resource referral as a part of integrated health care delivery for all its patients. Methods: We described the development of a screening tool, protocol, and creation of community resource referral materials. We also described the tracking of patient-reported needs and mapping of location and accessibility of community resources. One hundred patients were surveyed through convenience sampling, and results were used for program improvement. Results/Conclusion: After collecting and analyzing survey results, it was found that the 2 most frequently requested determinants were mental health and utilities services, and the most available community resource was emergency food services. We also mapped these results by zip code and found gaps between need and distribution of services. We demonstrated the utility of mapping to identify points of improvement for the future. We also provided lessons learned related to effective social determinants of health screening, community resource referral, and overall program implementation in student-run free clinics. We further explained the benefits of including similar student-led programs as a way for students to gain practical experience related to social determinants of health.

scholarly journals Social Determinants of Health and Health Care Delivery: African American Women’s T2DM Self-Management

2020 ◽  
pp. 105477382091698
Author(s):  
Judith M. Ochieng ◽  
Janice D. Crist
Keyword(s):  
Health Care ◽  
African American ◽  
Social Determinants Of Health ◽  
Health Care Delivery ◽  
Social Determinants ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Determinants Of Health ◽  
Self Management

African American (AA) women have high prevalence of Type 2 diabetes mellitus (T2DM) and complications. No studies have been conducted about how social determinants of health and health care delivery affect their T2DM self-management. The purpose was to describe how social determinants of health and healthcare delivery may influence AA women’s T2DM self-management using qualitative descriptive methodology ( N = 10). Ten participants were interviewed. Participants’ geographical location, education, level of income, health literacy, and systemic racism, that is, healthcare delivery services, for example, inadequate healthcare services, providers’ assumptions about the patient’s knowledge of diabetes, providers’ attitudes toward patients, and stigma related to diabetes as a disease were identified. Understanding the role of social determinants of health and the health care delivery system in influencing T2DM self-management is a powerful tool for providers and practitioners for improving practice and health care policies to decrease health disparities and improve health outcomes among AA women with T2DM.

scholarly journals Addressing Social Determinants While Social Distancing: The Development of an Evidence-Based Social Needs Screening for a Telehealth Setting

2021 ◽  
Author(s):  
Ruby Reed ◽  
María Suárez-Nieto ◽  
Jiwoo Lee ◽  
Neil Wary ◽  
Songnan Wang ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Patient Population ◽  
Clinical Care ◽  
Community Organizations ◽  
Social Needs ◽  
Determinants Of Health ◽  
Evidence Based ◽  
Free Clinics ◽  
The Social

Effectively addressing social determinants of health in clinical care can be challenging, and screening for such social needs is often overlooked. The COVID-19 pandemic has exacerbated health disparities and the impacts of social determinants of health, increasing the importance of both effective screening and intervention to address social needs. In response, the student-run free clinics at Stanford University sought to meet this need amongst our patient population by developing an evidence-based social needs screening (SNS) and referral protocol and integrating it into our novel telehealth model. The new protocol was implemented significantly more consistently compared to our previous checklist-based SNS, and more need was identified amongst our patient population than with the checklist-based, pre-pandemic screen. The new screening and referral protocol facilitated comprehensive patient care that addresses the social determinants of health in the clinical setting by improving our ability to identify patient social needs and refer such patients to community organizations. In describing the development, design, and implementation of this SNS, we hope to provide an example strategy for addressing social determinants of health within a student-run free clinic setting, and to encourage other student-run clinics and/or free clinics to similarly expand locally relevant social needs services.

The Impact of Social Determinants of Health in Facial and Craniomaxillofacial Reconstruction: Can We Do Better?

2021 ◽  
pp. 105566562110375
Author(s):  
Sumun Khetpal ◽  
Daniel C. Sasson ◽  
Joseph Lopez ◽  
Derek M. Steinbacher ◽  
Arun K. Gosain
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Care Delivery ◽  
Surgical Care ◽  
Multidisciplinary Care ◽  
Determinants Of Health ◽  
Facial Trauma ◽  
Multidisciplinary Care Team ◽  
The Impact ◽  
Team Model

Social determinants of health (SDOH) are integral to consider when delivering craniomaxillofacial and facial reconstructive care for patients. The American Cleft Palate-Craniofacial Association (ACPA) has instituted a formalized multidisciplinary care team model that recognizes such determinants and has aggregated patient-led organizations to strengthen patients’ education and support system. This review discusses the need for all surgeons engaged in facial and craniomaxillofacial reconstruction to consider SDOH in their practice. Additionally, we explore how factors such as race, insurance status, education level, cost, and access to follow-up care, impact surgical care for craniosynostosis, facial trauma, orthognathic surgery, head and neck cancer, and facial paralysis. We propose that the ACPA team model be applied to other societies that care for the broader scope of patients in need of facial and craniomaxillofacial reconstruction to strengthen the communication, collaboration, and standardization of care delivery that is personalized to the needs of each patient.

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