To improve health outcomes, ask patients about their income, access to food, housing

October 28, 2023

3 min read

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Key points:

  • Addressing the social determinants of health can improve health-related outcomes.
  • Use screening tools to assess food insecurity, housing, and social support needs.

BOSTON — Patients struggling to achieve cardiometabolic treatment goals may benefit from an assessment of social determinants of health, which may reveal food, housing or financial insecurity that play an important role in their health.

According to A. Enrique, approximately one-quarter of U.S. adults with self-reported diabetes are on track to achieve HbA1c levels below 8%, blood pressure below 140/90 mm Hg, non-HDL cholesterol below 130 mg/dL, and are non-smokers. Key Objectives” Caballero, MD, endocrinologist, clinical researcher, and director of the Center for Latino Diabetes Health, Division of Endocrinology, Diabetes and Hypertension, Brigham and Women’s Hospital; Faculty Director, International Innovation Programs, Office of External Education, Harvard Medical School; American Diabetes Association said the former chair of the Commission on Healthcare Disparities during a keynote address at the Cardiometabolic Health Conference.

A. Enrique Caballero, MD, quoted

“The reality is, we’re not having that big of an impact on patients,” Caballero said. “The vast majority of our patients are not seeing the benefits discussed at this conference. The question is: Why aren’t these benefits positively impacting more people?”

Caballero said that for many patients in under-resourced areas, social determinants of health, such as food access and food availability, neighborhood quality, income, occupation, access to health care and social supports, all play a role in health outcomes. Influence. Disparities in care contribute to exorbitant health care costs. About 70% of diabetes care costs are related to care for only 15% of patients in the Medicare system; Caballero said these patients are typically those with chronic complications related to diabetes, a large proportion of whom are racial and ethnic minorities. Ethnicity.

“Perhaps surprisingly, it is actually feasible to incorporate assessment of social determinants of health into routine clinical practice,” Caballero told Healio. “We just need to develop a solid and specific plan on how to work with our care team members and make it part of our daily assessments. Of course, it’s also important to provide patients with some practical options to address some of their challenges. is critical. This requires identifying resources in the community. Healthcare professionals may be surprised at how many community programs exist in their own communities.”

Assess patient needs and improve health

Caballero said patients who are considered “non-adherent” to their medications or prescribed lifestyle interventions often have relevant social factors that explain why:

  • Assess the patient’s socioeconomic status by discussing the patient’s education and occupation. Data shows that cost-related or cost-reducing nonadherence is related to income, insurance status and insurance type, Caballero said, noting that even with insurance, high copays can make it difficult or impossible for patients to afford their medications. cost. “I don’t think you would feel comfortable asking a patient, ‘Tell me how much money you make?'” Caballero said. “That’s not the way to go. But ask them what they do and if they have difficulty with their medications. It may feel uncomfortable at times, but it’s important to ask if our advice makes sense.”
  • Ask patients about their community and physical environment, including housing and any toxic environmental exposures. For example, issues such as community safety may affect whether patients are able to exercise outdoors where they live, Caballero said.
  • Food insecurity can be assessed using two validated screening tools, Caballero said. The first question should ask if the patient is worried that they will run out of food before they have the money to buy it; the second question should ask if the patient has run out of food in the past 12 months and has not money to get more food. “This is a significant problem; 14 percent of the U.S. population is food insecure,” Caballero said. “Imagine how ridiculous this is [it would be] If I say to such a patient: ‘You should have a salad for lunch. ‘”
  • How can patients get support? Clinicians should ask patients who their advocates are and whether they have family or friends who can help them with self-care or transportation to appointments.

Make time for social considerations

The challenge, Caballero said, is having these conversations with patients during health care visits of 15 minutes or less; however, clinicians must get creative in assessing social factors.

“Saying ‘Do this and see you in three months’ is not a good approach,” Caballero said. “It’s absolutely critical to assess all of these aspects. Perhaps a team can help gather this information. We need to do a better job of engaging with patients and eliciting these conversations in meaningful ways, and that requires cultural humility in order to more effectively engage with Patient interaction.”




Caballero AR. Screening for social determinants of cardiometabolic health and practical implications. Published in: Cardiometabolic Health Conference; October 18-21, 2023; Boston.

Caballero reported no relevant financial disclosures.

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