Social determinants of health like housing, education and employment can make a bigger difference in a person's health than clinical care. But to what extent, and in what ways, should primary care doctors be expected to address those issues?
That's one topic that's explored in the March/April issue of the Annals of Family Medicine, with different doctors taking various positions on the matter.
The lead authors of one editorial — Jennifer DeVoe, M.D., D.Phil., a practicing family physician and health services researcher at Oregon Health & Science University, and Andrew Bazemore, M.D., M.P.H., director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care — laid out the problem, saying "attempts to address (social determinants of health) in medical care settings have been limited and, for the most part, ineffective."
The editorial proposed a framework for integrating social determinants of health (SDOH) into primary care which would involve: first, establishing the routine collection of standardized SDOH data; second, systematizing that data into electronic health records that are readily and reliably available; and third, developing automated systems that harness SDOH data to prompt action such as referrals (what Healthify basically does).
In two companion editorials, which are cited and quoted in an AAFP news report, other doctors debated whether primary care should take on SDOH now.
"Expanding the role of primary care physicians...toward addressing evidence-based prevention screening and interventions is feasible if the health team is expanded," said Arthur Kaufman, M.D., vice chancellor for community health at the University of New Mexico Health Sciences Center. "Perhaps the most significant addition to the team are community health workers who spend more time addressing the SDOH than do other team members."
Leif Solberg, M.D., associate medical director at HealthPartners Medical Group offered an opposing view.
"There is no evidence that clinicians and care systems can either add this to their plates or have much impact on the social determinants of their patients," he said. "They certainly have no expertise or resources for this work, work that even the social service agencies created for this purpose find to be difficult, frustrating, and of limited success."
All of this new discussion in the Annals of Family Medicine comes amid the American Academy of Pediatrics' recent recommendation that pediatricians check up on young families' financial well-being.
That recommendation arose from recognizing the fact that child poverty in the country — a SDOH-related matter — hugely impacts children's health.
Healthify, which plays the role of efficiently connecting people to social services via a software tool, is premised on the idea that social determinants of health can and should be taken into account at the point of care.
But as we get into the nitty-gritty details of exactly how that ought to play out — whether doctors or social workers, or both, should take the lead to collect SDOH data and act on it — it'll be interesting to see what arrangement emerges to be the optimal solution.