Social Determinants of Health and Primary Care: Intentionality Is Key to the Data We Collect and the Interventions We Pursue

Hughes, Lauren S.

doi:10.3122/jabfm.2016.03.160120

Cited by 5 publications

(14 citation statements)

References 12 publications

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“…Public health policies could be better designed and their effects better assessed using linked health and socioeconomic data. [42, 57, 60, 66, 105–107, 113] The data could be utilised at the local and national level, [32, 44] in the planning and evaluation of wider policies, [10, 81] including transport and food policies. [60]…”

Section: Resultsmentioning

confidence: 99%

A systematic review of reasons for and against asking patients about their socioeconomic contexts

Moscrop

Ziébland

Roberts

et al. 2019

Int J Equity Health

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Background People’s social and economic circumstances are important determinants of their health, health experiences, healthcare access, and healthcare outcomes. However, patients’ socioeconomic circumstances are rarely asked about or documented in healthcare settings. We conducted a systematic review of published reasons for why patients’ socioeconomic contexts (including education, employment, occupation, housing, income, or wealth) should, or should not , be enquired about. Methods Systematic review of literature published up to and including 2016. A structured literature search using databases of medicine and nursing (pubmed, embase, global health), ethics (Ethicsweb), social sciences (Web of Science), and psychology (PsychINFO) was followed by a ‘snowball’ search. Eligible publications contained one or more reasons for: asking patients about socioeconomic circumstances; collecting patients’ socioeconomic information; ‘screening’ patients for adverse socioeconomic circumstances; or linking other sources of individual socioeconomic data to patients’ healthcare records. Two authors conducted the screening: the first screened all references, the second author screened a 20% sample with inter-rater reliability statistically confirmed. ‘Reason data’ was extracted from eligible publications by two authors, then analysed and organised. Results We identified 138 eligible publications. Most offered reasons for why patients’ should be asked about their socioeconomic circumstances. Reasons included potential improvements in: individual healthcare outcomes; healthcare service monitoring and provision; population health research and policies. Many authors also expressed concerns for improving equity in health. Eight publications suggested patients should not be asked about their socioeconomic circumstances, due to: potential harms; professional boundaries; and the information obtained being inaccurate or unnecessary. Conclusions This first summary of literature on the subject found many published reasons for why patients’ social and economic circumstances should be enquired about in healthcare settings. These reasons include potential benefits at the levels of individuals, health service provision, and population, as well as the potential to improve healthcare equity. Cautions and caveats include concerns about the clinician’s role in responding to patients’ social problems; the perceived importance of social health determinants compared with biomedical factors; the use of average population data from geographic areas to infer the socioeconomic experience of individuals. Actual evidence of outcomes is lacking: our review suggests hypotheses that can be tested in future research.

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Section: Resultsmentioning

confidence: 99%

A systematic review of reasons for and against asking patients about their socioeconomic contexts

Moscrop

Ziébland

Roberts

et al. 2019

Int J Equity Health

View full text Add to dashboard Cite

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“…Both in Michigan and nationally, consistent measures are greatly needed to monitor SDH across a national population of differing communities, values, and resources. 15 Selecting these measures will be critically important to ensure proper monitoring of and feedback on how HCs and other providers identify needs and take necessary action steps to improve health. Core domains will allow for trackable metrics across communities to monitor individual SDH, population health, community needs, available ancillary services, and allocation of resources.…”

Section: Discussionmentioning

confidence: 99%

Screening for Social Determinants of Health in Michigan Health Centers

et al. 2017

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Objective: Through an academic-community partnership with a statewide consortium of health centers (HCs) in Michigan, we characterize the current scope of screening for social determinants of health (SDH).Methods: We requested copies of forms used to screen for SDH at the 39 HC organizations in Michigan. Using content analysis, we examined variation in screening domains and processes. We present descriptive analyses of HC characteristics and patient demographics.Results: We received screening documentation from 23 of the 39 HCs (59%), representing 167 delivery sites. We found broad empiric consensus regarding a core set of 13 SDH screening domains that align with nationally recommended screening guidelines. Two additional domains, Culture and Functional Status, were screened for by <40% of HCs. While patient self-report is the most frequent mode of SDH screening (41%), many HCs use staff members to administer the screening documents.Conclusions: HCs across a large and diverse state are screening for SDH and largely agree on core SDH screening domains. Using existing empiric data from frontline providers can inform potential best practices in SDH screening. (J Am Board Fam Med 2017;30:418 -427.)

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“…1,9,13 Many health systems are already taking steps to collect these SDH through a combination of strategies such as collecting data directly from patients, using publicly available data, or using geographic information systems to assign census-based variables. [14][15][16][17][18][19][20][21] Early views on this transformation reveal that common concerns include the privacy and ethical considerations 22 linked to possessing social risk data with limited health system infrastructure and psychosocial skills [22][23][24] to address them. An unintended consequence of such a setup could be the erosion of the patient-physician relationship.…”

Section: Introductionmentioning

confidence: 99%

Provider Perspectives on the Collection of Social Determinants of Health

Palacio

Seo

Medina

et al. 2018

Population Health Management

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Social determinants of health (SDH) impact health outcomes. Medical centers have begun to collect SDH data, urged by government and scientific entities. Provider perspectives on collecting SDH are unknown. The aim is to understand differences in views and preferences according to provider characteristics. A cross-sectional survey of University of Miami clinical faculty was conducted in late 2016. The survey contained 11 questions: 8 demographic and departmental responsibilities questions and 3 Likert scale questions to capture collection and use of SDH perspectives. The main outcome was whether providers thought the benefit of collecting SDH outweighs the burden and risks. In all, 240 faculty members were included. The majority were men (64%), with a mean age of 51 years. Among participants, 53.5% were non-Hispanic white, 32% were Hispanic, 5% were Black/African American, and 5% were Asian. The majority agreed that SDH are important predictors of health outcomes and quality of care (83%). When comparing minority to nonminority faculty, 25% believed that SDH should only be available to PCPs, compared to 8% of nonminorities (P < 0.01). In a multivariate model, belonging to a racial ethnic minority was the only characteristic associated with believing that benefits of collecting SDH outweigh the risks (odds ratio 1.87, 95% confidence interval 1.02- 3.5) after adjusting for age, sex, minority status, health care provider type, type of responsibilities, and department. This study reveals that although most providers of a health system believe social risks impact health outcomes and quality metrics, the buy-in to collect SDH varies according to the racial/ethnic composition of the faculty.

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Social Determinants of Health and Primary Care: Intentionality Is Key to the Data We Collect and the Interventions We Pursue

Cited by 5 publications

References 12 publications

A systematic review of reasons for and against asking patients about their socioeconomic contexts

A systematic review of reasons for and against asking patients about their socioeconomic contexts

Screening for Social Determinants of Health in Michigan Health Centers

Provider Perspectives on the Collection of Social Determinants of Health

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