Question

How do you think the social determinants of health of a given patient population should influence how we think about healthcare value delivery? What role might HIT play in that context? For example, in one my past roles we found that certain social determinants were strongly correlated with a tendency to be non-adherent to drug therapy for chronic conditions.

Answer 1

Ans) Addressing social determinants of health is a primary approach to achieving health equity.

- Health equity is “when everyone has the opportunity to ‘attain their full health potential’ and no one is ‘disadvantaged from achieving this potential because of their social position or other socially determined circumstance'”.

- Health equity has also been defined as “the absence of systematic disparities in health between and within social groups that have different levels of underlying social advantages or disadvantages—that is, different positions in a social hierarchy”.

- Social determinants of health such as poverty, unequal access to health care, lack of education, stigma, and racism are underlying, contributing factors of health inequities.

- The Centers for Disease Control and Prevention (CDC) is committed to achieving improvements in people’s lives by reducing health inequities. Health organizations, institutions, and education programs are encouraged to look beyond behavioral factors and address underlying factors related to social determinants of health.

- The World Health Organization (WHO)external icon created the Commission on Social Determinants of Healthexternal icon to address social determinants of health.

- The Commission uses the following three principles to guide its work in eliminating health inequities for local communities and nations and throughout the world:

Improve the conditions of daily life—the circumstances in which people are born, grow, live, work, and age.
Tackle the inequitable distribution of power, money, and resources—the structural drivers of those conditions of daily life—globally, nationally, and locally.
Measure the problem, evaluate action, expand the knowledge base, develop a workforce that is trained in the social determinants of health, and raise public awareness about the social determinants of health.
- The commission created the conceptual framework below that describes relationships among individual and structural variables. The framework represents relationships among variables that are based on scientific studies or substantial evidence. The framework provides a point from which researchers can take action, such as creating targeted interventions, on social determinants of health.

- The Five Denominations of Social Determinants In a nutshell, the social determinants of health have a major accountability in an individual's ability to understand the importance of healthcare. It directly connects to the availability and access to care and enhancing their health.

- Understanding the cost, transportation, or social barriers a patient may face to achieving persistent medication adherence will be essential to improving patient care in a meaningful way.

Address cost: Medical providers should first identify patients who may be experiencing cost barriers to their medications using patient-provider communication skills. From there, providers can prioritize different prescriptions, refer patients to subsidy programs, and flag lower-cost pharmacies.

Connect patients to pharmacy services: Primary care clinicians and other providers and help patients who may experience transportation barriers access the pharmacy through the use of rideshare partnerships, other non-emergency medical transportation, or home delivery pharmacy options.

Aid medication management and self-efficacy: Patients experiencing specific social issues, including low socioeconomic status, language barriers, or low educational attainment may have more difficulty managing medications than other, less vulnerable populations. Connecting patients with management tools while providing health coaching and patient education may help improve self-efficacy.

Increasing medication adherence has the potential to improve patient outcomes and eliminate avoidable healthcare costs, two tenets of effective population health.