Meaningful chronic disease management is a key aspect of value-based healthcare. After all, a sizeable portion of healthcare spending can be attributed to a small share of the nation’s sickest patients, underscoring the need to manage illness.
But with this shift comes a growing realization that care management is more than just medical practice; it’s an acknowledgment that the social determinants of health (SDOH) impact chronic disease.
These factors that determine a patient’s ability to obtain wellness can keep patients from engaging in healthy behaviors, accessing healthcare, and keeping their disease state of symptoms under control.
Below, PatientEngagementHIT outlines the key social determinants of health that affect chronic disease management and how the healthcare industry has begun to address them.
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Where a patient lives, not her genetic makeup, has emerged as a central social determinant of health. Geography can play a role in a patient’s educational attainment, housing security, public safety or exposure to violence, and in many cases income.
But perhaps most importantly to chronic disease management, geography can limit patient access to care, which ultimately can define how healthy a patient is.
For example, individuals living in rural regions face challenges when accessing care simply because a medical facility is located far away from their homes. At the same time, rural-dwelling patients are more likely to report poorer health and chronic illness.
People living in rural areas face up a 17-minute trip to the nearest local hospital, compared to only 10 minutes for those living in urban areas and 12 minutes for those in suburban areas, according to a December 2018 poll from the Pew Research Center.
This has resulted in significant patient care access barriers, the analysis added. A May 2018 survey also conducted by Pew confirmed that 23 percent of rural dwellers say access to good doctors at a reasonable distance is a challenge in their communities. Eighteen percent of those living in urban areas and 12 percent in suburban towns said the same.
Overall, 18 percent of patients live more than 10 miles from their nearest hospital, the report added.
Telehealth has shown some promise for overcoming the geography hurdle. In 2017, researchers from the University of California Davis found that specialty telemedicine visits reduced distance traveled by 5 million miles for all patients receiving that care between 1996 and 2013. This amounted to nearly nine years’ worth of saved travel time and $3 billion in saved travel costs.
But implementing telehealth in rural areas faces another significant hurdle: broadband connection. The technology hinges on a strong internet connection, which simply does not exist in many rural localities, at least at the time of publication.
If telehealth is truly to address this key social determinant of health, the industry must work out permanent and effective reimbursement models and ensure strong infrastructure for rural-dwelling patients.
Income is a critical social determinant of health that has wide-ranging impacts on patient wellness. While socioeconomic status has a number of downstream or secondary affects — geographic location, educational attainment, housing security, and food security, to name a few — it also takes a direct toll on patient health and chronic disease management.
That is because socioeconomic status can determine whether a patient can afford to engage with her healthcare.
Source: PatientEngagement HIT