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ACP launches new initiative to improve patient care, promote health equity
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NEW ORLEANS — American College of Physicians officials discussed their recently-released position paper that outlined how they plan to address social determinants of health, an “extremely important issue in health care.”
“[Social determinants are] where you live, how you grew up, your environment, the level of food and emotional security, economic status, and the like ... that affect health and health care outcomes,” Jack Ende, MD, MACP, president, ACP, said at a press conference.
“You can probably look at just about any state in the union, and identify maps where within miles, a person’s life expectancy can drop by as much as 15 years,” he said.
“All over America, there are teams that work to ensure patients are healthy, but sometimes our toolbox of medicines and skills don’t get us there. The reasons are these social determinants of health... Sometimes we need to look outside our medical and clinical space to ensure our patients are healthy,” Sarah Candler, MD, MPH, chair-elect, ACP's Council of Resident/Fellow Members added.
The College’s approach, outlined in the position paper, entails:
- Supporting increased efforts to assess and apply public policy interventions with the goal of reducing socioeconomic inequalities that have a detrimental impact on health.
- Supporting increased interprofessional communication and collaborative models that inspire team-based approaches to treating patients at risk to be negatively affected by social determinants of health.
- Supporting the concept that agencies receive “adequate and efcient” funding to handle the social determinants of health, especially those that lower costs to the health care system and health differences, or those that yield the greatest and do away with redundancies.
- Supporting thorough, increased research into the the social determinants of health.
- Recommending that social determinants of health and affiliated health inequities be assimilated into medical education at all levels.
- Recommending increased screening and collection of social determinants of health data to aid in health impact assessments and support evidence-driven decision making.
- Recommending policymakers embrace a “health in all policies” approach and enforce the integration of health considerations into community planning decisions through the utilization of health impact assessments.
- Recommending the creation of best practices for using EHR systems to improve individual and population health without increasing the administrative burden on physicians.
- Recommending changing performance measurement assessments and quality payment models to acknowledge the increased risk linked to caring for disadvantaged patient populations.
The approach will involve data and multiple partners, Karen DeSalvo, MD, MPH, MSc, president-elect, Society of General Internal Medicine, who also attended the press conference said those at the press conference said.
“We cannot create standalone silos of data and information. In this generation of thinking of health beyond health care, we must create systems that are not only part of our workload, but those of our social services partners ... and can help us address these social determinants.”
She suggested resources such as Health Leads, Aunt Bertha, and UniteUs as for gathering data.
In a related editorial to the position paper, David U. Himmelstein, MD and Steffie Woolhandler, MD, MPH of The City University of New York at Hunter College and Harvard Medical School said the ACP “offers useful guidance” as well as “altruistic (if vague) advice on policy advocacy.”
“I would have to take issue with that,” Ende said, when asked about Himmelstein and Woolhandler’s comments. “This is not vague advice. I believe we are at very exciting time where this becomes a part of every medical school and resident’s experience. We’ve gotten way beyond becoming soft. This is not fuzzy, this is quite real.”
Candler said the very nature of ACP’s mission, as well as how very few communities are alike, necessitates approach.
“The role of [ACP] is not to be proscriptive with rules and regulations about these things but to recognize the importance of having general guidelines and policy about this,” she said. “The social determinants of health are different for everyone ... it would be irresponsible to give too specific of a guideline.”
She added that while members of the medical community come up with plans to address the social determinants, the most important thing primary care physicians and internists can do right now is listen to their patients.
I’ve had patients tell me at the end of our visits that they are so glad that someone hears them. It doesn’t matter if I gave them anything physical, what matters is that I gave them a relationship and the space to feel trusted and supported”
Himmelstein and Woolhander also wrote that the recent overhaul of the U.S. tax law makes the rich richer and only minimally helps the poor, making address the social determinants of health. They also suggested President Donald J. Trump and his cabinet are only furthering the divide.
“Many immigrants are now afraid to travel, report unsafe working or housing conditions, or seek care... The administration's endorsement of aggressive policing, incitement of racial animus, and lax civil rights enforcement may exacerbate race-based health inequities. Its efforts to curtail access to reproductive care seem likely to increase unwanted pregnancies and even maternal mortality. The relaxation of air quality standards will increase cardiovascular and pulmonary deaths, and climate change denialism portends profound health consequences.”
Himmelstein and Woolhander encouraged physicians to remember the patients as they move forward in their endeavors.
“Physicians' voices carry great weight when we speak selflessly on behalf of patients. Our profession must act forcefully with hope and courage,” they wrote.
“We underacknowledge our importance as advocates for our patients,” Candler added at the press conference. “Even if there is nothing we think we can do at that moment for our patient ... our job as a primary care doctor, as a physician, as an internist, our job is to advocate and to recognize that [these social determinants] exist and ask for something to be done.”
In addition to ACP, the American Academy of Family Physicians recently launched the EveryONE project toolkit to help its members address these same social determinants.
Various components will be released throughout the year and a survey will be taken later this year to assess members’ response to the toolkit.
“Our goal is not to put the entire burden on the family physician, but rather involve the whole office team, and also tap into community resources that address the social determinants of health. We don’t want to add a lot of time to the physician’s day, we want to support patient care, which can lead to better health outcomes,” Julie K. Wood, MD, MPH, the Academy’s senior vice president of health of the public and interprofessional activities told Healio Family Medicine earlier this year about its initiative. – by Janel Miller
Reference:
AAFP.org. “The EveryONE Project.” https://www.aafp.org/patient-care/social-determinants-of-health/cdhe/everyone-project/tools.htm
Daniel H, et al. Ann Intern Med. 2018;doi:10.7326/M17-2441.
Himmelstein DU and Woolhandler S. Ann Intern Med. 2018;doi:10.7326/M18-0335.
Social Determinants of Health, Press briefing at: American College of Physicians annual meeting; April 17-21, 2018; New Orleans.
Disclosures : Candler is chair-elect, ACP's Council of Resident/Fellow Members; DeSalvo is president-elect, Society of General Internal Medicine; Ende is president of ACP; Wood is AAFP’s senior vice president of health of the public and interprofessional activities.