Embed Size (px)
Citation preview
Social Determinants of Care
• The following module is designed as a basic overview of the social determinants of care for providers of healthcare, particularly those in a patient-centered medical home.
• At the end of this module, the reader should be able to:– Define “social determinants of care”– Name 3 major components of the social determinants of
care– Outline potential areas where patient centered care can
impact the social determinants of care
Every day in patient care…
Social Determinants of Health• The complex, integrated, and overlapping social
structures and economic systems that are responsible for most health inequities. These social structures and economic systems include the social environment, physical environment, health services, and structural and societal factors. Social determinants of health are shaped by the distribution of money, power, and resources throughout local communities, nations, and the world. CDC.gov
What are the Social Determinants of Care?
Patients do not have to live in abject poverty to be affected
*Family of 4 = 23,050 in 2012Median Charleston 2011 = 50,133 (US Census)
Social Determinants are “Hereditary”
Where can the PCMH make a difference?
MSW
NursingPolicy
MD Patient
PharmD
Affordable Care Act sets up changes
POPULATION HEALTH MANAGEMENTVolume 13, Supplement 2, 2010
The PCMH can focus on Personal Behavior
• Self management – encouraging healthy lifestyles
• Medication management – education and strategizing for adherence
UK – Proposed solutions (April 2013)
Example of Behavioral InterventionFigure S4 Effectiveness of physician offer of behavioural assistance in quitting versus physician advice to quit on medical grounds on long-term abstinence (top), attempts to quit (middle), and abstinence among those attempting to stop (bottom)
Study or Subgroup
Slama 1990
Total (95% CI)
Total eventsHeterogeneity: Not applicableTest for overall effect: Z = 1.53 (P = 0.13)
Events
5
5
Total
101
101
Events
1
1
Total
106
106
Weight
100.0%
100.0%
M-H, Fixed, 95% CI
5.25 [0.62, 44.14]
5.25 [0.62, 44.14]
Experimental Control Risk Ratio Risk RatioM-H, Fixed, 95% CI
0.01 0.1 1 10 100Favours control Favours experimental
Study or Subgroup
Slama 1990
Total (95% CI)
Total eventsHeterogeneity: Not applicableTest for overall effect: Z = 3.28 (P = 0.001)
Events
58
58
Total
101
101
Events
36
36
Total
106
106
Weight
100.0%
100.0%
M-H, Fixed, 95% CI
1.69 [1.24, 2.31]
1.69 [1.24, 2.31]
Experimental Control Risk Ratio Risk RatioM-H, Fixed, 95% CI
0.5 0.7 1 1.5 2Favours control Favours experimental
Study or Subgroup
Slama 1990
Total (95% CI)
Total eventsHeterogeneity: Not applicableTest for overall effect: Z = 1.05 (P = 0.29)
Events
5
5
Total
58
58
Events
1
1
Total
36
36
Weight
100.0%
100.0%
M-H, Fixed, 95% CI
3.10 [0.38, 25.51]
3.10 [0.38, 25.51]
Experimental Control Risk Ratio Risk RatioM-H, Fixed, 95% CI
0.01 0.1 1 10 100Favours control Favours experimental
Addiction. 2012 Jun;107(6):1066-73.
Behavioral and Prevention Interventions: Focus on Action
• Nutrition/diet• Smoking cessation • Diabetes teaching• Hypertension teaching• Reflux lifestyle control• Vaccines• Etc.
Questions
• I have read each slide in this module and understood its content– True– False
