Patient-Centered Care and Social Determinants of Health

Patient-Centered Care

  • Principles:

    • Respect for the patient

    • Involvement of patient in care decisions

    • Sharing of decision-making responsibilities

  • Challenges in Implementation:

    • Healthcare providers may feel they know best for patients, but patient involvement is crucial.

    • Example: Patient may trust outside opinions more than physician's advice (e.g., cinnamon for diabetes).

Importance of Patient Involvement

  • Outcome Impact:

    • Patients often resist advice from providers if they feel superior or rebellious (e.g., "You need to lose weight" scenario).

  • Examples in Practice:

    • Doctors might display a visual (e.g., X-ray of bones) to counter the belief of being "big-boned."

Social Determinants of Health

  • Definition:

    • Factors affecting health that extend beyond the physical health of the individual, incorporating community context.

    • Assesses aspects such as where people live, work, and social conditions.

  • Impacts on Health:

    • Social determinants play a significant role in determining a community’s health outcomes (up to 80%).

    • Lack of safe walking areas can discourage physical activity.

    • Personal anecdote: Inadequate neighborhood safety affects exercise habits due to fear of encountering dangerous people.

Upstream vs. Downstream Factors

  • Upstream Factors:

    • Policies and systemic factors that lead to health outcomes (e.g., lack of sidewalks, legislative barriers).

  • Downstream Factors:

    • Immediate individual health issues that could be mitigated by addressing upstream factors.

Health Disparities

  • Definition:

    • Differences in health outcomes among different population groups based on systemic inequities.

    • Examples provide insights into avoidable gaps, often systemic (preventable).

  • Equity vs. Equality:

    • Equality: Everyone receives the same resources, but this doesn’t ensure adequate care for everyone.

    • Equity: Everyone receives what they need, recognizing different starting points.

Case Studies and Real-World Examples

  • Patient Encounter at ER:

    • Example of a non-emergency visit motivated by lack of access to care (e.g., pregnant women seeking ultrasounds).

    • Highlights issues of emergency room misuse due to inadequate insurance or support systems.

Healthy People 2030 Objectives

  • Key Domains:

    • Economic Stability

    • Education

    • Access to Healthcare

    • Neighborhood and Built Environment

    • Social and Community Context

  • Local Education Quality:

    • Schools may fail due to systemic issues, affecting health literacy and outcomes.

The Role of Nurses and Care Management

  • Health Care Access Barriers:

    • Nurses should be equipped to recommend resources for food security, healthcare access, and more.

    • Awareness of local programs and service availability is essential.

Legislation and Healthcare Policy Change

  • Affordable Care Act (ACA):

    • Aimed to increase insurance coverage but didn't guarantee access to care (many doctors don’t accept Medicaid).

    • Example of problematic insurance coverage that does not equate to treatment access.

  • Successful Advocacy Example:

    • A nursing experience resulting in a policy change that allowed Medicaid to cover transportation via rideshare services (e.g., Uber, Lyft).

Maternal Health Disparities

  • Case Study - Jasmine:

    • 29-year-old African American woman experiencing systemic barriers during pregnancy.

    • Highlights lack of grocery options, psychological barriers to care, and transportation issues affecting health outcomes.

  • Issues Identified:

    • Maternal health disparities particularly affecting African American women, including poor treatment experiences during labor and difficulty accessing timely prenatal care.

Group Reflection and Discussions

  • Group Activity: Discuss social determinants that could affect the case study and relate it back to learnings from the lecture.