Patients are focused on social
determinants of health that impact their day-to-day lives, while policymakers
are concerned with institutional barriers.
By Sara Heath
June 12, 2019 - Differences
in how patients and their providers talk about the social determinants of
health (SDOH) could have an impact on how healthcare industry stakeholders
design social services programs, according to a new paper from the Anthem Public Policy
Institute.
The SDOH include the
social factors that impact a patient’s ability to achieve health and wellness.
Industry leaders and patients agree that addressing those factors will be
important to cutting overall healthcare spending and improving quality
outcomes, but there are key differences about which of those factors providers
should primarily focus on.
“While there has been
a lot in the media and academic research on social determinants of health, no
one has ever compared the focus of that work with the perspectives of
individuals who have chronic or acute conditions to determine whether their
priorities are aligned,” Jennifer Kowalski, vice president of the Anthem Public
Policy Institute, said in a statement.
“By better
understanding how individuals view and talk about social determinants, payers and
providers alike can identify new and improved ways to engage with them to more
effectively improve their health and wellbeing and the delivery of healthcare.”
The researchers
analyzed the text in policy and research papers regarding SDOH, as well as online
patient forums for those managing cancer, mental illness, or a diabetes
diagnosis. That analysis revealed that while providers focus on the
big-picture, institutional SDOH, patients are far more concerned with the
day-to-day matters that impact their health.
Specifically,
patients were more likely to cite a need for more healthcare support, with 44
percent saying that access to the right medical provider impacts their ability
to achieve health. Those managing mental illness discussed a need for more
emergency mental healthcare facilities, while those with cancer noted a need to
access the best facilities for their specialized care plans.
Additionally, 25
percent of patients discussed the role of social support as a social
determinant of health. Patients said they needed more social support from their
family or friends, while others explained that they have truly benefitted from
caregiver support.
Usually patients with
cancer or diabetes fell into the former category, while patients with mental
illness fell into the latter, the researchers observed.
Twelve percent of
patients, primarily those managing diabetes, also referenced access to
nutritious food.
“For individuals with
diabetes, posts about managing food intake and diet overlapped with concerns
about social support,” the researchers pointed out. “Posters without a family
history of diabetes wrote about the difficulties of knowing what to eat without
having anyone to ask for help. Relatives sought advice about how to promote and
support healthy eating habits among their loved ones.”
Patients reporting
one SDOH often noted issues with another, the researchers said, underscoring
the connections between different healthcare needs. For example, challenges
with medical transportation may have also
been tied to limited social support – that patient may not have a loved one who
could drive them to the doctor’s office.
Meanwhile,
journalists, researchers, and public policymakers talked more about bigger
picture items, such as education or income level. These areas are a lot more
difficult to change and require more resources to build interventional
programming.
In total, 22 percent
of the public narrative centered on education while 20 percent centered on
economic stability. Seventeen percent of public literature discussed healthcare access.
These differences
have the potential to create a dissonance between the support programs that
providers design and what patients say they actually need, the researchers
continued. Policymakers may busy themselves with plans to improve economic
equality, while patients say they need more nutritious food in their pantries.
The researchers
suggested policymakers focus more on the factors that are important to
patients. After all, these efforts will resonate more with a population that is
more concerned with meeting their own needs day-by-day. These factors may also
be more impactful, the researchers suggested.
“Individuals appear to focus on factors that
may be more easily modifiable (e.g., increased social support, better access to
healthy food), while the academic literature is focused on structural factors
(e.g., education) that may take more time and greater resources to address,”
the research team suggested.
“The gap between
these differing perspectives highlights opportunities to improve the health and
wellbeing of individuals—in particular by addressing social connectedness and
community support.”
Specifically, public
policymakers should consider following:
·
Investing in community health
programming
·
Increasing community healthcare
navigation
·
Integrating social and clinical data
to identify high-needs patients
·
Continuing to evaluate social
programming to assess evolving patient need
·
Supporting community health policies
“Better understanding
the perspective of individuals, including the barriers they encounter, can help
payers and providers enhance health and healthcare,” the researchers concluded.
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