Primary Care Case Conferences to Mitigate Social Determinants of Health: A Case Study From One FQHC System

2021 ◽  
Vol 9 (4) ◽  
pp. 12-19
Keyword(s):  
Primary Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Case Conferences

scholarly journals Exploring the local policy context for reducing health inequalities in children and young people: an in depth qualitative case study of one local authority in the North of England, UK

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eleanor Holding ◽  
Hannah Fairbrother ◽  
Naomi Griffin ◽  
Jonathan Wistow ◽  
Katie Powell ◽  
...  
Keyword(s):  
Child Health ◽  
Social Determinants Of Health ◽  
Health Inequalities ◽  
Social Determinants ◽  
Qualitative Case Study ◽  
Determinants Of Health ◽  
Local Policy ◽  
Inequalities In Health ◽  
The North

Abstract Background Improving children and young people’s (CYP) health and addressing health inequalities are international priorities. Reducing inequalities is particularly pertinent in light of the Covid-19 outbreak which has exacerbated already widening inequalities in health. This study aimed to explore understandings of inequality, the anticipated pathways for reducing inequalities among CYP and key factors affecting the development and implementation of policy to reduce inequalities among CYP at a local level. Methods We carried out a qualitative case study of one local government region in the North of England (UK), comprising semi structured interviews (n = 16) with service providers with a responsibility for child health, non-participant observations of key meetings (n = 6 with 43 participants) where decisions around child health are made, and a local policy documentation review (n = 11). We employed a novel theoretical framework, drawing together different approaches to understanding policy, to guide our design and analysis. Results Participants in our study understood inequalities in CYP health almost exclusively as socioeconomically patterned inequalities in health practices and outcomes. Strategies which participants perceived to reduce inequalities included: preventive support and early intervention, an early years/whole family focus, targeted working in local areas of high deprivation, organisational integration and whole system/place-based approaches. Despite demonstrating a commitment to a social determinants of health approach, efforts to reduce inequalities were described as thwarted by the prevalence of poverty and budget cuts which hindered the ability of local organisations to work together. Participants critiqued national policy which aimed to reduce inequalities in CYP health for failing to recognise local economic disparities and the interrelated nature of the determinants of health. Conclusions Despite increased calls for a ‘whole systems’ approach to reducing inequalities in health, significant barriers to implementation remain. National governments need to work towards more joined up policy making, which takes into consideration regional disparities, allows for flexibility in interpretation and addresses the different and interrelated social determinants of health. Our findings have particular significance in light of Covid-19 and indicate the need for systems level policy responses and a health in all policies approach.

scholarly journals How 6 Organizations Developed Tools and Processes for Social Determinants of Health Screening in Primary Care

2018 ◽  
Vol 41 (1) ◽  
pp. 2-14 ◽  
Author(s):  
Kate LaForge ◽  
Rachel Gold ◽  
Erika Cottrell ◽  
Arwen E. Bunce ◽  
Michelle Proser ◽  
...  
Keyword(s):  
Primary Care ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Health Screening ◽  
Determinants Of Health

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.

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