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Paying attention to the social determinants of health may be a powerful way of improving cardiovascular outcomes.
Specialists tend to be valued primarily for their medical expertise, so when a physician takes time to get to know a patient, the doctor is usually praised for having a good bedside manner.
But growing evidence shows that knowing about a patient’s life is also crucial to quality of care. For cardiologists, familiarity with those social and educational realities may mean the difference between ineffectual care and achieving desired health outcomes.
Sonia Anand, M.D., Ph.D., a professor of medicine and epidemiology at McMaster University in Hamilton, Ontario, Canada, told Managed Healthcare Executive® that social determinants of health (SDOH) should play a critical role when physicians create care plans. “The physician needs to understand their patients’ SDOH situation to choose the medications, follow-up plan and future appointments,” she said. Anand noted, though, that time constraints may make it difficult for physicians to ask questions related to SDOH. Still, there is significant evidence that SDOH are not properly attended to. Results of a study reported in the Journal of Health Care for the Poor and Underserved in 2015 showed that one-third of patients had uncertain access to food, housing or money to pay bills, yet less than half (41.6%) of patients said their physicians were consistently aware of those struggles.
Even when SDOH screenings take place, physicians may have difficulty translating the information into useful decisions. While various indices are available to help physicians account for SDOH, Monika M. Safford, M.D., of Weill Cornell Medicine in New York City, New York, told Managed Healthcare Executive® that regional differences can affect those scores in ways that make it difficult for a physician to interpret on a case-by-case basis.
But it turns out that merely tracking the number of SDOH problems a patient has may yield some insights, even if the physician cannot fully quantify the impact of any single factor. Safford and her colleagues recently published a study in Circulation that involved correlating SDOH data and coronary heart disease (CHD) outcomes in more than 22,000 patients.
Adjusted for age, the data showed a clear increase in risk as the number of social determinants increased, regardless of the type; for instance, the incidence of fatal coronary heart disease events per 1,000 person years was 1.30 for people with no SDOH problems and 2.86 for people with three or more. For nonfatal myocardial infarction, the rate per 1,000 person years was 3.91 among people with no SDOH problems, but 5.44 among people with two or more. “(A) simple count of widely available (SDOH) may be a novel approach to identify individuals at high risk of incident CHD events that could be used in the course of clinical care,” Safford and her colleagues wrote.
The results suggest that even a basic SDOH interview could translate into meaningful results. “Education, where they live, whether the area is in a physician shortage area, which state you’re in, how isolated they are socially, their race/ethnicity, their health insurance — all these are recommended parts of the social history,” Safford said. “So, in a nutshell, the information we included in the study should be routinely collected as part of high-quality healthcare, albeit indirectly for annual household income.”
Jared Kaltwasser is a healthcare writer in Iowa.