Social determinants of health in pulmonary arterial hypertension patients in the United States: Clinician perspective and health policy implications

Abstract

Social determinants of health (SDoH) can impact the vulnerable pulmonary arterial hypertension (PAH) population, especially during the COVID‐19 pandemic. Providers' understanding of SDoH at the point of care and their impact is unknown. We conducted semi‐structured virtual interviews with US clinicians at 17 pulmonary hypertension (PH) centers and one patient advocate from the Pulmonary Hypertension Association. We sought participants' perspective on SDoH in PAH and their impact. Transcripts were developed and analyzed for key themes to assess potential policy implications. Participants served a large PAH population and demonstrated high awareness of SDoH and its impact on treatment and outcomes. They reported that patients' SDoH, including socioeconomic status, health insurance, access to health care, education levels, health literacy, employment status, and insecurities associated with housing, food, transportation, and family support, impacted health and well‐being. COVID‐19‐related social isolation, mental health, and substance abuse contributed to significant inequities in care provision and outcomes. While telemedicine helped clinicians manage patients remotely during the pandemic, there was a concern for patients with limited access to this medium. Participants reported no formal screening for SDoH at the point of care. With the recognition and the desire to act upon health inequities associated with SDoH, participants felt that it was vital for their centers to have a dedicated PH social worker and support staff to optimize care and outcomes. An approach that integrates SDoH in PAH care management, streamlined through institutional policy, could address health disparities leading to improved healthcare access, outcomes, and quality of care.

International trends in pulmonary hypertension mortality between 2001 and 2019: Retrospective analysis of the WHO mortality database

“…At the end of the observation period (2017–2019), the highest 3-year mortality was observed in Georgia, Romania, and America. Inconsistent time trends of mortality across countries might be caused by multiple reasons, including different population composition, unequal access to PH care, and different criteria [ 31 ]. Currently, early diagnosis and available treatment remain a grand challenge due to limited healthcare resources in some low- and middle-income countries [ 32 ].…”

Impact of the COVID‐19 pandemic on chronic disease management and patient reported outcomes in patients with pulmonary hypertension: The Pulmonary Hypertension Association Registry

“…There may be additional social factors contributing to patient outcomes that are unmeasured by our data. One qualitative study of pulmonary hypertension providers highlights this issue‐ despite providers' understanding that social determinants of health are large contributors to poor access to diagnostic and therapeutic care for PH patients, these are under‐captured metrics in current screening tools at intake or follow‐up visits for PH patients 23 …”

The social and economic disadvantage in pulmonary hypertension: A work (still) in progress

“…We read with great interest the article “ Social determinants of health in pulmonary arterial hypertension patients in the United States: Clinician perspective and health policy implications ” by Nadipelli et al 1 The social and political events that transpired during the year 2020 brought into attention the significance of socioeconomic status and race/ethnic segregation as crucial factors affecting social equality. For instance, at the beginning of the coronavirus disease 2019 (COVID‐19) pandemic, emphasis was placed on a simple yet effective strategy for disease mitigation (“flattening of the curve”): social isolation.…”

“…Nadipelli et al 1 describe an analysis of perspectives on the significance of SDOH among medical professionals caring for patients with PAH. The authors conducted semistructured interviews, which were then transcribed and coded for common themes using a qualitative methodology.…”

“…Despite its limitations, the study of Nadipelli et al 1 is important for several reasons. First, it provides insight into perceived SDOH and the barriers that need to be overcome to achieve health equality (see Figure 1 ).…”