The Relationship Between Social Determinants of Health and Functional Capacity in Adult Primary Care Patients With Multiple Chronic Conditions

Abstract Social prescribing (SP) is an innovative approach to tackle social determinants of health. It enables general practitioners (GPs) to address non-medical causes of ill-health by linking primary care patients with non-medical community sources of support. Despite convincing results from punctual evaluations, comprehensive evaluation of SP is needed to provide guidance on what works and evidence on its impact. A SP pilot-project started in 2018 in a primary care service in Lisbon. Its implementation process and outcomes are being evaluated through a longitudinal mixed-method evaluation study assessing patients’ wellbeing, quality of life, anxiety and depression in key stages of the intervention and stakeholders’ perspectives on facilitators/barriers to the intervention implementation. GPs refer patients to a social worker of the service, who defines with the patient the individual intervention plan using community resources. Initially, GPs and social workers were trained on SP, a network of community partners was built, SP information was distributed to patients, a referral online platform was created and a baseline study is being conducted. In the 1st semester, 130 patients were referred: 39.2% were ≥65 years old, 70.8% were female, 45.4% had foreign nationality. Over two thirds were referred for multiple reasons mostly social isolation, immigration/social integration, mental health, sedentary lifestyle, access to social benefits and employment/skills training. The project has enabling to support patients with multiple complex psychosocial needs. Regular meetings between GPs and partners have improving collaboration and patients’ supervision. The participatory approach and training emerged as facilitators of the intervention. Yet, the increased burden on social workers due to growing referral profile and some stakeholders’ scepticism toward SP need to be addressed. The triangulation of sources, methods and data provide evidence on the intervention impact and scalability. Key messages The social prescribing intervention has been effective in tackling multiple social determinants of health. Intervention evaluation is being key to identify facilitators and opportunities for scale up.

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Training Medical Residents to Address Social Determinants of Health for Better Health Outcomes

Innovation in Aging ◽

10.1093/geroni/igaa057.830 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 258-259

Author(s):

Angela Zell ◽

Joan Ilardo ◽

Adesuwa Olomu ◽

Cristian Meghea ◽

Supratik Rayamajhi

Keyword(s):

Social Determinants Of Health ◽

Social Determinants ◽

Chronic Conditions ◽

Local Community ◽

Patient Activation ◽

Resident Training ◽

Determinants Of Health ◽

Medical Residents ◽

Patient Response ◽

Future Clinical Practice

Abstract Gaps exist in training medical residents to assess social determinants of health (SDOH) related to chronic conditions. To address the need for better screening, we partnered with two Internal Medicine (IM) residency programs based in Lansing and Flint (Michigan) to pilot the Caring for Patients with Chronic Conditions (CPCC) project. IM residencies train internists with expertise in diagnosis, treating chronic conditions, promoting health through wellness education, and preventing and managing diseases. CPCC incorporated information during didactic sessions that residents could apply during their clinical activities that can influence their current and future clinical practice patterns. Presentations and panels from local community organizations on specific topics were incorporated into the curriculum that address needs of patients age 50 and older. To build on this education, the residents adapted the Office- Guidelines Applied in Practice (Office-GAP) checklist to identify SDOH affecting a patient’s ability to managed chronic conditions. Using this tool: 1) involves resident training; 2) provides a decision support checklist; 3) influences patient activation; and 4) increases provider and patient communication through shared decision making. The checklist includes questions for patient response pertaining to SDOH that prevents them from managing their chronic conditions in addition to the level of action the patient is willing to do. Areas identified are discussed between patient and resident increasing patient activation. Referrals to community-based resources to identified SDOH needs are guided by the clinic’s care manager. The Office-GAP tool is administered during three subsequent visits to ensure that patients actually accessed the community resources.

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Limitations on Participation and Their Relation to Social Determinants of Health Among Occupational Therapists and Occupational Therapy Students During Coronavirus Lockdown

American Journal of Occupational Therapy ◽

10.5014/ajot.2021.049050 ◽

2021 ◽

Vol 75 (6) ◽

Author(s):

Nuria Menéndez Álvarez ◽

Emiliano Diez Villoria ◽

Estíbaliz Jimenez Arberas ◽

Ana María Castaño Pérez ◽

Antonio León García Izquierdo

Keyword(s):

Occupational Therapy ◽

Social Determinants Of Health ◽

Social Determinants ◽

Occupational Therapists ◽

Determinants Of Health ◽

World Health ◽

International Classification Of Functioning ◽

Occupational Therapy Students ◽

The Impact ◽

The Relationship

Importance: For the first time in recent history, people worldwide have faced severe restrictions in occupations because of the measures adopted by governments to contain the coronavirus disease 2019 (COVID-19) crisis. Objective: To determine the limitations on participation of occupational therapists and occupational therapy students during “lockdown” and their impact on social determinants of health. Design: A cross-sectional, descriptive study conducted via an online survey. Participants: A total of 488 occupational therapists and occupational therapy students in North America, South America, and Europe. Outcomes and Measures: A questionnaire consisting of the World Health Organization Disability Assessment Schedule 2.0 of the International Classification of Functioning, Disability and Health and items developed to assess the impact of lockdown on daily life was emailed to occupational therapy professional associations, organizations, and universities between April and June 2020. It was available in English, Spanish, and Portuguese and met all the parameters listed in the Declaration of Helsinki. Results: The roles and routines of people across the developed world have been affected by lockdown measures. The study shows marked differences between participants in the domains of getting along and life activities, as well as influence on the environment. Moreover, South American participants experienced these difficulties to a greater extent than European participants. Conclusions and Relevance: This study quantifies the limitations in the participation of occupational therapists and occupational therapy students and the relationship of occupation to social determinants of health. What This Article Adds: The results of this research corroborate the relationship between health and occupation and highlight elements, such as the environment and context, that are important in occupational therapy. Therapists’ ability to analyze occupation in relation to contextual and cultural factors will benefit clients.

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Association of adult attachment and suicidal ideation in primary care patients with multiple chronic conditions

Journal of Affective Disorders ◽

10.1016/j.jad.2018.12.029 ◽

2019 ◽

Vol 246 ◽

pp. 121-125 ◽

Cited By ~ 1

Author(s):

Ina-Maria Rückert-Eheberg ◽

Karoline Lukaschek ◽

Katja Brenk-Franz ◽

Bernhard Strauß ◽

Jochen Gensichen

Keyword(s):

Primary Care ◽

Suicidal Ideation ◽

Adult Attachment ◽

Chronic Conditions ◽

Multiple Chronic Conditions ◽

Primary Care Patients

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Evaluation of an educational online intervention aiming to improve primary care physicians’ awareness of addressing social determinants of health in clinical care in Saudi Arabia

http://isrctn.com/ ◽

10.1186/isrctn14600984 ◽

2021 ◽

Author(s):

Basmah Almujadidi

Keyword(s):

Primary Care ◽

Saudi Arabia ◽

Social Determinants Of Health ◽

Social Determinants ◽

Primary Care Physicians ◽

Clinical Care ◽

Online Intervention ◽

Determinants Of Health

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An Educational Initiative to Affect Poverty and Social Determinants of Health-Related Knowledge and Attitudes in Primary Care Settings

Journal of Health Care for the Poor and Underserved ◽

10.1353/hpu.2020.0059 ◽

2020 ◽

Vol 31 (2) ◽

pp. 756-766

Author(s):

Ruselle S. DeBonis ◽

Jacqueline R. Meyer ◽

Lisa D. Brodersen

Keyword(s):

Primary Care ◽

Social Determinants Of Health ◽

Social Determinants ◽

Determinants Of Health ◽

Educational Initiative ◽

Knowledge And Attitudes ◽

Primary Care Settings ◽

Health Related

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Developing a critical realist informed framework to explain how the human rights and social determinants of health relationship works

BMC Public Health ◽

10.1186/s12889-019-7760-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Fiona Haigh ◽

Lynn Kemp ◽

Patricia Bazeley ◽

Neil Haigh

Keyword(s):

Human Rights ◽

Social Determinants Of Health ◽

Social Determinants ◽

Critical Realism ◽

Determinants Of Health ◽

Construction Of Knowledge ◽

Critical Realist ◽

Significant Relationships ◽

The Social ◽

The Relationship

Abstract Background That there is a relationship between human rights and health is well established and frequently discussed. However, actions intended to take account of the relationship between human rights and social determinants of health have often been limited by lack of clarity and ambiguity concerning how these rights and determinants may interact and affect each other. It is difficult to know what to do when you do not understand how things work. As our own understanding of this consideration is founded on perspectives provided by the critical realist paradigm, we present an account of and commentary on our application of these perspectives in an investigation of this relationship. Findings We define the concept of paradigm and review critical realism and related implications for construction of knowledge concerning this relationship. Those implications include the need to theorise possible entities involved in the relationship together with their distinctive properties and consequential power to affect one another through exercise of their respective mechanisms (ways of working). This theorising work enabled us identify a complex, multi-layered assembly of entities involved in the relationship and some of the array of causal mechanisms that may be in play. These are presented in a summary framework. Conclusion Researchers’ views about the nature of knowledge and its construction inevitably influence their research aims, approaches and outcomes. We demonstrate that by attending to these views, which are founded in their paradigm positioning, researchers can make more progress in understanding the relationship between human rights and the social determinants of health, in particular when engaged in theorizing work. The same approaches could be drawn on when other significant relationships in health environments are investigated.

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