Social Determinants of Health

Aka: Social Determinants of Health

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II. Definitions

  1. Social Determinants of Health (SDOH)
    1. Socioeconomic factors that influence the physical and mental health status of individuals and populations

III. Precautions

  1. Social Determinants of Health drive up to 80% of healthcare outcomes (contrast with 20% by medical care)

IV. Types

  1. Social and Community
    1. Social isolation
    2. Racism or discrimination
    3. High risk of Violence
  2. Neighborhood and Structural Environment
    1. Lack or reliable transportation
    2. Unsafe housing or neighborhood
    3. Air or water pollution
  3. Healthcare
    1. Lack of healthcare access
  4. Education
    1. Language difficulty or illiteracy
    2. Lack of Educational opportunities
  5. Economic Stability
    1. Lack of job opportunities or reliable income
    2. Unable to afford medications
    3. Inadequate access to nutritious foods

V. History: Screening

  1. See Hunger Vital Sign Screen
  2. Consider SDOH screening questions via the EHR or on patient rooming
  3. Consider screening tools (see resources from AAFP and Prapare as below)
  4. Standardize screening as to avoid bias (allow for resources for all patients)
  5. Ask open ended questions about SDOH
  6. Document findings in a consistent section of the EHR
  7. Ask about reason for missed appointments (e.g. transportation?) and unfilled prescriptions (e.g. cost?)

VI. Management

  1. See Food Insecurity Resources
  2. See Transitions of Care
  3. See Medication Cost Assistance Program
  4. Have available information and referrals to assist patients in accessing resources (e.g. FindHelp and 211, as below)
  5. Partner with local public health (U.S. county level) to develop a local resource list for patients and specific needs
  6. Work with patients using the resources they do have (e.g. virtual visits or phone calls)

VII. Prognosis: Factors associated with improved outcomes

  1. Access to nutritious food in adequate amounts
  2. Safe Housing (e.g. protection from environmental factors and pollution, free of abuse)
  3. Access to quality healthcare
  4. Safe neighborhoods (e.g. lower crime rates, less Violence)
  5. Ready access to transportation
  6. Educational access (literacy, language skills)
  7. Job Opportunities
  8. Income and financial security
  9. Decreased discrimination and reduced racial and ethnic barriers

VIII. Resources: Patients

  1. FindHelp.org
    1. https://www.findhelp.org/
  2. United Way 211
    1. https://www.211.org/

IX. Resources: Providers

  1. AAFP SDOH Screening Tools
    1. https://www.aafp.org/family-physician/patient-care/the-everyone-project/toolkit/assessment.html
  2. Prapare Screening Tool
    1. https://prapare.org/
  3. AAFP Neighborhood Navigator
    1. https://navigator.aafp.org/
  4. AAFP Everyone Project
    1. https://www.aafp.org/family-physician/patient-care/the-everyone-project.html
  5. Social Determinants of Health (Healthy People 2030)
    1. https://health.gov/healthypeople/priority-areas/social-determinants-health

X. References

  1. (2023) Presc Lett 30(7): 38-9
  2. Pierre (2022) Am Fam Physician 106(4): 427-38 [PubMed]

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