scholarly journals Measuring social determinants of health and their impact on service use and medical complexity

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Dan Chateau ◽  
Alan Katz ◽  
Chelsey McDougall ◽  
Carole Taylor ◽  
Scott McCulloch
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Complexity ◽  
Primary Care Providers ◽  
Determinants Of Health ◽  
Care Providers ◽  
Complex Patients ◽  
Medical Complexity

IntroductionPopulation based data on the social determinants of health are not widely available, despite a wide body of evidence pointing to their importance. The Mantioba Population Research Data Repository offers a unique opportunity to leverage data from multiple government departments to assess the relationship between measurable social determinants and health. Objectives and ApproachUsing population based data from health, small area level census survey questions, social assisitance, education, social housing, child protective services and justice, linked at the individual level, we measured indicators of social complexity and mapped them in the province of Manitoba. Individuals with high level of social complexity were then compared with indicators of medical complexity and/or high use of medical services to determine the degree of overlap between these attributes of individuals. A matched group of individuals without any of the measured social complexities was developed and the number and reason for visits to primary care providers was compared. ResultsThe rate of individuals having three or more social complexities varied from a low of ~7% to a high of 35%, depending on the geographic location. High residential mobiity, involvement with the justice system and history of social assistance were the most frequent (>15%). Individuals with social complexities tended to be younger and live in poorer neighbourhoods than medically complex individuals or high users of health services. Socially complex persons had on average 5.5 primary care visits annually, compared to only ~3.5 for matched individuals with no social complexities. The overlap with high users of health services was slight (14.4%) and depended on the characteristics of the population. The overlap with medically complex patients ws higher (16.2%), particularly when medical complexity included mental health related diagnoses (20.4%). Conclusion/ImplicationsThe proportion of individuals with social complexities is large, and a substantial number have multiple risk factors. These individuals are for the most part a unique group, distinct from medically complex patients. Different strategies for care may be necessary to promote and sustain mental and physical health and wellbeing.

scholarly journals Teaching Family Medicine Residents How to Identify and Address Social Determinants of Health

PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Lisa Schoenberger ◽  
Rajaa Mourabet ◽  
Binju Bose ◽  
Qian Gu ◽  
Benita Benjamin ◽  
...  
Keyword(s):  
Family Medicine ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Screening Tool ◽  
Primary Care Providers ◽  
Practical Experience ◽  
Social Needs ◽  
Determinants Of Health ◽  
Care Providers ◽  
Family Medicine Residents

Introduction: This educational program aimed to teach family medicine residents how to address social determinants of health. The literature reviewed suggested that curricula addressing social needs of patients were sporadic and failed to provide residents with practical ways to apply the knowledge. The program objectives were to provide residents with a thorough understanding of social determinants of health and to provide a practical experience where they could address social needs. Methods: The program consisted of four didactic sessions in which the residents discussed why addressing social determinants of health is important, designed a screening tool, and were educated on how to assess and communicate with patients. As a longitudinal experience, the residents used the screening tool in their clinic and connected patients with resources. We performed a mixed-methods data analysis to determine if program goals were met. Results: Survey data showed a statistically significant change in the comfort, understanding, and consistency of addressing social determinants of health. Reflections showed similar results. Residents recognized the importance of being aware of social needs, having conversations with patients about their needs, and considering cost when they implement treatment plans.  Conclusions: Family medicine residents are the future primary care providers for our communities. Therefore, it is important to equip them with the knowledge and ability to address all of the factors affecting their patients’ health. Graduates will be able to apply this knowledge to their future patients, and educators can be assured family physicians have the skills to address social determinants of health.

The Bridge Program: A Model for Delivering Mental Health Services to Asian Americans through Primary Care

2005 ◽  
Vol 3 (1) ◽  
pp. 13-29 ◽  
Author(s):  
Hongtu Chen ◽  
Elizabeth Kramer ◽  
Teddy Chen ◽  
Jianping Chen ◽  
Henry Chung
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Asian Americans ◽  
Mental Health Professionals ◽  
Primary Care Providers ◽  
Care Providers ◽  
Bridge Program ◽  
Community Awareness

Compared to all other racial and ethnic groups, Asian Americans have the lowest utilization of mental health services. Contributing factors include extremely low community awareness about mental health, a lack of culturally competent Asian American mental health professionals, and severe stigma associated with mental illness. This manuscript describes an innovative program that bridges the gap between primary care and mental health services. The Bridge Program, cited in the supplement to the Surgeon’s General’s Report on Mental Health: Culture, Race, and Ethnicity as a model for delivery of mental health services through primary care; (2) to improve capacity by enhancing the skills of primary care providers to identify and treat mental disorders commonly seen in primary care; and (3) to raise community awareness by providing health education on mental health and illness. Results are presented and the potential for replication is addressed.

scholarly journals Teaching Family Nurse Practitioner Students to Provide Mental Health Care to Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 10-11
Author(s):  
Victoria Grando ◽  
Roy Grando
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Treatment Plan ◽  
Primary Care Providers ◽  
Neurocognitive Disorders ◽  
Mental Condition ◽  
Care Providers

Abstract In recent years, FNPs have been challenged to deliver mental health services in the primary care setting. Over half of mental health services are provided in primary care, and one-quarter of all primary care patients have a mental disorder. Moreover, 20% of older adults have a mental or neurological disorder often not diagnosed. Nationally, it is estimated that 17% of older adults commit suicide, 15% have a mental condition, 11% have dementia, and 5% have a serious mental condition. There is a paucity of adequately prepared primary care providers trained in geropsychiatric treatment. A didactic course was developed to instruct FNP students in the skills needed to provide mental health treatment in primary care. We discuss mental illness in the context of culture to ensure that treatment is congruent with a patient’s unique cultural background and experiences. This shapes the patients’ beliefs and behaviors that influence the way they view their condition and what they perceive as acceptable solutions. We then go into detail about the common mental conditions that older adults exhibit. Through the case study method, students learn to identify the presenting problem, protocols for analyzing the case, which includes making differential diagnoses and a treatment plan including initial medications, non-medical treatments, and referral. Students are introduced to the DMS-5 to learn the criteria for mental health diagnosis with an emphasis on suicide, depressive disorders, anxiety disorders, bipolar disorders, substance use disorders, and neurocognitive disorders. We have found that students most often misdiagnose neurocognitive disorders.

Conclusion

2020 ◽  
pp. 421-426
Author(s):  
Adrian Bonner
Keyword(s):  
Young People ◽  
Health Services ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Children And Families ◽  
Local Authorities ◽  
Health And Wellbeing ◽  
Large Numbers ◽  
Health Model

This concluding chapter explains that in order to develop interrelationships and interdependencies across the various domains within a social determinants of health rainbow model, there needs to be a good understanding and respect for each of these contributions to the health and wellbeing of people and their communities. In the ten-year period of austerity preceding the COVID-19 crisis, many local authorities have radically reduced their social and health services for children and families and young people, concentrating solely on those with the most acute need, those whom they have a legal obligation to support. Indeed, local government has 'retreated from its historical position as the front-line of defence against social evils'. There remain major concerns about local authorities' ability to support their communities in the post-COVID-19 period. Ultimately, although there are large numbers of reports and reviews aimed at local commissioning policies and practices, there is very little evidence to support the interrelated and interdependent approaches utilising a social determinants of health model that specifically addresses 'wicked issues'.

scholarly journals 38. Understanding Variations In Primary Care Providers’ Perceptions And Practices In Implementing Confidential Sexual Health Services For Adolescents

2019 ◽  
Vol 64 (2) ◽  
pp. S20-S21
Author(s):  
Renee E. Sieving ◽  
Christopher J. Mehus ◽  
Marina Catallozzi ◽  
Stephanie A. Grilo ◽  
Annie-Laurie McRee ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Sexual Health ◽  
Primary Care Providers ◽  
Care Providers

Using Community-Level Mental Health Surveillance Data to Examine the Relationship of Depression Prevalence to Social Determinants of Health and Access to Mental Health Services

2013 ◽  
Vol 32 (1) ◽  
pp. 43-57 ◽  
Author(s):  
Shawn R. Currie ◽  
Kirsten Fiest ◽  
Lindsay Guyn
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Low Income ◽  
Community Level ◽  
Determinants Of Health ◽  
Treatment Access ◽  
Depression Prevalence

The effect of social determinants of health on depression prevalence and treatment access was examined using community survey and administrative data on mental health service users in the Calgary Health Region (CHR). Consistent with national prevalence data, depression was significantly associated with female gender, younger age, and health risk factors such as smoking, hypertension, and obesity. The prevalence of depression causing interference in daily functioning across 19 social districts (subregions within the CHR) was significantly related to community-level indicators of single-parent status, low-income families, and low educational achievement in each district. Disparities in treatment access were also found with persons living in the most impoverished districts having the lowest rates of accessing professional mental health services.

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