Path to Prioritizing SDoH in Whole Person Chronic Care: Q&A series featuring Dr. Cyaandi Dove, D.P.M.

To truly make a difference in patients' lives, we must take a compassionate and holistic approach to care. By delving into the social determinants of health (#SDoH), we can better understand and address their unique challenges. It's not just about treating symptoms but tackling the systemic, environmental, and social factors that impact their well-being.?

In this edition of our SDoH Q&A series, we are honored to discuss this vital topic with Dr. Cyaandi Dove, D.P.M., who is the Director of Clinical Research at the Department of Orthopedics, Division of Podiatry at the University of Texas Health Science Center at San Antonio. She earned a Doctor of Podiatric Medicine degree at the California College of Podiatric Medicine in San Francisco. She also completed her residency at the University of Texas Health Science Center and a surgical fellowship at North General Hospital in New York. Dr. Dove oversees NIH trials, industry-sponsored trials, inter-department educational initiatives, and other projects at the University of Texas Health Science Center in San Antonio.

Q: What should clinicians be asking their patients living with chronic conditions to better understand the challenges they face specific to SDoH?

Before asking these questions, I suggest clinicians remind themselves that the social determinants of health (SDoH) are pivotal in successful treatment outcomes. Clinicians must find a way to incorporate and highlight patients' responses to these questions. Considering those factors, I think the patient's support system is mission-critical. If a robust support system exists in terms of family and friends, clinicians should encourage patients to incorporate them into the treatment plan. Encouraging a patient to engage their support system to become a valued ally in their treatment plan holds the potential to help improve outcomes.??

Secondly, I find many of the most rudimentary components of patient care are overlooked. Transportation to visits, insurance issues, and living conditions are frequently overlooked. Patients frequently are reluctant and embarrassed to discuss these vital issues with the providers. It is the duty of the provider to obtain this information in a respectful, compassionate manner from the patient. Providers should also be aware that patients may have a strong connection with the support staff. In my experience, patients frequently disclose crucial information to the assistants instead of the physician for fear of being labeled non-compliant. With that in mind, the physician should find the most appropriate team members to gather this sensitive information.

Q: Are there any approaches your organization or other leading organizations in healthcare are taking to prioritize SDoH needs for people living with chronic diseases?

I'm beginning to see electronic medical records (EMRs) integrate SDoH questions. However, this is very early and must go through real-world scenarios before it becomes meaningful and actionable. Still, providers should not be afraid to collaborate with the EMR teams to make the SDoH questions more meaningful. Maximizing the impact of SDoH insights in the EMR can be as simple as modifying the language used to ask a question.

Q: What should an SDoH-first approach to care actually look and feel like for a patient?

Before a clinician has a face-to-face visit, a pre-visit assessing SDoH should be performed. Frequently, determining SDoH is a brief afterthought.?

Moving forward, an SDoH alert or triage system should be embedded into EMR. For example, if a patient lives alone and is semi-mobile, is it fair to expect this patient to remain non-weight-bearing and perform complex dressing changes to a wound? Clearly, the answer is no. This patient would need additional support to follow the doctor's orders and ensure the best possible outcomes. Incorporating patient responses relating to SDoH into the EMR as part of the treatment plan for patients would be ideal. It is harder to forget the patient's needs when the treatment plan is flagged with an unaddressed SDoH challenge.

Q: How can patients best communicate their SDoH needs to their care providers?

Patients should be encouraged to schedule a separate visit to discuss and address these issues. Large and small institutions need to find site-specific solutions for collecting SDoH data and making it actionable. For example, if a clinic is overloaded, social workers can be indispensable in finding creative solutions and resources for patients.??

Q: If people are not receiving the care they need related to SDoH, where else can they go for support beyond their primary care provider and team of care specialists?

In large hospital settings, there are patient advocates and social workers. But, despite best practices, there are still failures with this treatment paradigm.

Patients can also think beyond the medical setting and look to their communities. There are religious-based institutions and grassroots community groups that dedicate time and resources to aiding members of the community who are in distress.?

We cannot expect patients who feel unheard to turn to the older systems that have failed them historically. Institutions and clinicians should take the time to familiarize themselves with local resources so they can support patients holistically.

On a personal level, I make an effort to learn about the county, city, and state resources available for patients. These organizations typically use their limited resources for patient care and have little left for advertising. These incredible organizations are often passionate and dedicated to helping the local community but are often under the radar. I've had great success working hand in hand with local, grassroots organizations.

Q: When clinicians are more overburdened than ever, how can they best prioritize SDoH in the shortened care visit of today and beyond?

We need to get creative! A triage system or pre-visit system needs to exist to guide clinicians. Part of the demographic intake should also involve asking about SDoH so the provider can take a deeper dive during the visit. Technology must be used to propel us towards better outcomes.?

Not every patient needs a detailed visit regarding SDoH, but identifying those at risk can make a tremendous difference.

Also, addressing essential issues regarding patient care should be a team effort. Front desk staff, medical assistants, and office managers can help to address many of the issues patients face.??

As I mentioned before, this should be a dedicated visit. Having a stand-alone visit with the at-risk patient will make it clear that we need to address and rectify any concerning issues regarding their treatment plans.

Q: What innovations specific to SDoH do you think hold the greatest promise today and in the next five years?

I think the integration of remote patient monitoring and EMRs holds the greatest potential for advancing medical care. As the medical community understands the importance of SDoH, I believe we will see the data on this grow in leaps and bounds.??

EMRs will become a tool to facilitate addressing SDoH challenges. This will take time and the feedback of clinicians, patients, and all healthcare sectors. It is an exciting time to see the burgeoning interest and action regarding understanding and addressing the impact of SDoH.