Social Determinants of Health

 

Health starts long before illness and

our family's Homes, Schools and Jobs many Coloradans experience barriers to good health due to interfering factors in their lives these factors are social determinants of Health and can make health care more challenging for healthcare providers and patients.

Some examples of these include income, education, race and ethnicity. But there are many more in a typical healthcare appointment. There may be signs that a patient is struggling with challenging life circumstances, which may inhibit successful treatment. However, there are also many ways healthcare providers can help patients get the care. They need despite such challenges, every visit is an opportunity to identify the social determinants affecting a patient's health and utilize creative solutions to help overcome those barriers.

Good morning hi I'm here for an appointment at nine with Dr. Wilson all right let me see what I can do transportation affects the health care of many Coloradans looks like I can still get you in today next time if you're more than 15 minutes late. We're going out to reschedule sorry about that 22 out of 29 Colorado communities surveyed about their healthcare. Needs identified this as a major issue causing late arrivals missed appointments and hesitancy to make follow-up appointments. Transportation affects people's ability to get to their Doctor's Offices on time and also to be able to stay for that appointment. 

So, if you have to use the bus you have to get a ride with a friend. It can really impact them in anybody's ability to actually even get there. 

It's not only important for the well visits and the kids to get their shots but the sick ones have to come back to be seen again. Otherwise, it's incomplete care lack of transportation is also one of the main reported reasons. low-income patients may be forced to rely on more expensive care in the emergency room. over managing their healthcare needs with a primary care provider alright go ahead and fill this up.

Literacy and Health Literacy are also important social determinants of health. 10% of Colorado adults lack basic literacy skills meaning, they are unable to read and comprehend a simple block of text. This makes completing tasks like filling out forms following written instructions or locating an expiration date on prescriptions difficult. 

We can take you back now additionally studies suggest patient comprehension may be compromised if content exceeds a middle school reading level. Most medical information was found to be written between a high school and college graduate level. I think the handout is a good thing but it can also we feel like we're covered as a provider by just being able to give this patient a handout. 

So, actually talking to the patient about so what do you want out of this appointment what can we do for you and then saying here's this handout and then going over it with them to be like. 

This is more for you at home but right now you're here I'm here what do you need to know what can we do to improve your health outcomes looking at your medical record. I really think it's important that we get your blood pressure under control, as well as your hyperlipidemia. The reason I mention that with an elevated blood pressure I really enjoy nursing and the role of nurses as being the bridge for the patient because sometimes they'll have a very long very. 

What I think is a wonderful encounter with their provider but when it's finished they have no idea what just happened and they obviously they do but they didn't get out of it.

What they needed I had a patient today and the medical student was saying have you ever had an MI the answer is yes but the patient was like no anybody in your family no even though he was in for a follow-up or an MI, which is a heart attack of myocardial infarction but they didn't ever say do you have any problems with your heart and; so it's always nice to kind of step back and say so what questions did you have for your provider where can we fill in those blanks not speaking the same language further complicates literacy 17% of Coloradans speak a language other than English and of those only 6% speak English very well. This interferes with the Doctors ability to successfully interact with the patient. In our practice, we see mostly refugees from around the world.

 

So often even if there is an interpreter there are still issues that arise. Sometimes, the chief complaint of the patient some of the interesting ones I hear are my teeth are burning or I have a fire inside. You're still getting a cultural barrier in terms of what the patient is meaning when they say these words so when trying to explain to a patient what I'm talking about, I try to keep so me amount of props in the office if I prescribe an inhaler.

 I can demonstrate with a model inhaler one of the most fun examples I've found is Google Images for example you type in hpylori in Google Images and instantly you have a hundred pictures, where you can click on and it shows the bacteria itself and the patient will get the picture real quick.

Income is a significant factor in a person's ability to access the healthcare system and stay healthy. 30 percent of Colorado households live with incomes below $35,000, 13 percent of Coloradans did not see a Doctor due to cost want to check with you, how you're doing on your medicines, how are you doing taking your medicine. 

Well I've been taking one but I haven't been taking the others 12 percent of Coloradans did not fill a prescription due to cost. It's very important for, we as pharmacists and for the providers of the patients as well to understand where the patients are coming from maybe a little bit of their background and how they struggle with the affordability of their medications that being said maybe the providers would be a little more open than to providing a generic prescription versus a brand-name prescription and open to insurance suggestions of providing what they call prior authorizations or changing medications to something that would be on their formulary and would be a little less expensive for the patient.

 I'd like to give you this prescription for your elevated cholesterol patients with lower incomes have limited access to healthy food, quality housing and other things that affect their health status. Income is one of those invisible but yet really important obstacles to getting good care. I mean there's the obvious obstacle of if you're low income and you don't have insurance but there's the more overlooked issue of how does income affect.

Every aspect of that person's life and is it visible to the physician during the encounter or is it not so, you need to one be able to ask the tough question of are you going to have a hard time affording this medication or will you have a hard time getting yourself to see this specialist or affording their copay can you afford the time off from work to go to these treatments or to come back in for rechecks and really have that heart-to-heart to know what they're capable of doing all of the different roadblocks.

Health care are magnified when a patient has a complex life and complex health needs which can become a vicious cycle. low-income Coloradans have fewer resources to manage their health care and are more likely to suffer from multiple chronic conditions than upper income Coloradans then things like missed appointments confusion about care instructions and unfilled prescriptions.

All contribute to a decline in health which becomes even harder to manage one of the hallmarks of a complex patient is simply having more than one chronic illness. They have diabetes hypertension and thyroid disease layered on top of that, they may also have morbid obesity layered on top of that, they may also have limited resources, no insurance provider layered on top of that, they may also have mental health issues as a clinician. 

As a physician it really involves recognizing that no one person can take on six steps of change all at once much less ten or fifteen or twenty, so with all of these complexities one of the most important things that we can help our patients with is being able to prioritize and without that skill caring for this population becomes very very challenging the field of medicine is a science but the practice of healthcare is an art that acknowledges the whole of the patient's life. The question is does having empathy for your patients, allow you to better take better care of them and I think the answer is yes without empathy or without understanding and without putting yourself in their place. It's challenging to be able to provide good care but we're not here because we want to make a diagnosis. 

We're here because when I make people healthy and I think you got to appreciate, where people are coming from, what their abilities are, what resources they have, what community resources exist for them; and incorporate that into your patient management.

So, it makes it more challenging but it makes it more fulfilling because you can actually be more successful if you think this way.

Do comments if you have some reliable suggestions. Be happy and stay blessed with healthy life.