How to Better Integrate Social Determinants of Health into Primary Healthcare: Various Stakeholders’ Perspectives

Abstract

This paper aims to identify challenges and opportunities related to the integration of social determinants of health (SDH) into primary healthcare at an international symposium in Orford, Quebec, Canada. A descriptive qualitative approach was conducted. Three focus groups on different topics were led by international facilitators. Two research team members took notes during the focus groups. All the material was analyzed using a thematic analysis according to an inductive method. Many challenges were identified, leading to the identification of potential opportunities: integrate the concept of SDH in all phases of the training curriculum for health professionals to foster interprofessional and intersectoral collaboration and sociocultural skills; organize healthcare for better outreach to vulnerable populations; organize local and regional committees to develop management frameworks to produce and use territory-specific data; develop dashboards for primary healthcare providers describing the composition of their territory’s population; work collaboratively, rallying primary healthcare providers, community organization delegates, patient partners, citizens, and municipality representatives around common projects. Discussions prompted new directions for further primary healthcare research, among which are building on best practices in the literature and in the field, and engaging various stakeholders in research, including vulnerable populations, while focusing on patient experience.

Integrating Social Care into Healthcare: A Review on Applying the Social Determinants of Health in Clinical Settings

“…(4) Which SDH screening tools were used in clinical settings? and (5) What were the challenges, lessons, and recommendations in integrating SDH in clinical settings [46]? In addition, we noted the types of US healthcare facilities that integrated SDH in clinical settings, including their geographical locations, when indicated.…”

“…External and internal factors facilitated SDH screening in clinical settings. External factors included grant requirements [70], encouragement from professional organizations and stakeholders [56,63,70], engagement with community partners [46,50,54,79], state and federal policies and laws [18,46,50,65,77,85], and third-party payer motivation [18,48,52,56,65,77,81]. Of these external factors, third-party payers were identified as one of the most important motivators to SDH implementation.…”

“…Other important external motivators identified by multiple studies in this review were federal and state policies and laws. Of particular note was the impact of the 2010 Patient Protection and Affordable Care Act (ACA), specifically the requirements for tax-exempt hospitals to conduct community health needs assessments (CHNA) every three years [46,65,77]. In addition to mandating CHNAs, the ACA also required tax-exempt hospitals to report on an implementation strategy for addressing the social needs in the communities that they serve [46,65].…”

“…Of particular note was the impact of the 2010 Patient Protection and Affordable Care Act (ACA), specifically the requirements for tax-exempt hospitals to conduct community health needs assessments (CHNA) every three years [46,65,77]. In addition to mandating CHNAs, the ACA also required tax-exempt hospitals to report on an implementation strategy for addressing the social needs in the communities that they serve [46,65]. To fulfill this requirement, hospitals frequently engaged in charity care, housing initiatives, and other community-building activities [18,46].…”

“…In addition to mandating CHNAs, the ACA also required tax-exempt hospitals to report on an implementation strategy for addressing the social needs in the communities that they serve [46,65]. To fulfill this requirement, hospitals frequently engaged in charity care, housing initiatives, and other community-building activities [18,46]. Additionally, state-level policies exerted a profound influence on how healthcare facilities address SDH in their communities.…”