Among more than 600,000 primary care patients, half live with some degree of social challenge, which has a negative effect on the quality of care they receive. Researchers in Manitoba, Canada identified 11 social complexities, such as low income, mental health diagnosis, and involvement with the justice system. Fifty-four percent of patients had at least one social complexity, and four percent had more five or more. Social complexity was strongly associated with poorer outcomes on primary care indicators for prevention, e.g., breast cancer screening (OR 0.77, 99% CI); managing chronic disease, e.g., diabetes (OR 0.86, 99% CI); care of older adults, e.g., benzodiazepine prescriptions (OR 1.63, 99% CI); and use of health services, e.g., ambulatory visits (OR 1.09, 99% CI). Patients with more social complexities were less likely to receive preventive services and more likely to seek ambulatory or emergency care. To achieve better health equity for vulnerable patient populations, the authors recommend expanding interdisciplinary team-based care tailored to individual practices' patient populations and exploring alternative funding models that acknowledge the complexity of addressing social determinants of health in the primary care setting.
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Association of the Social Determinants of Health With Quality of Primary Care
Alan Katz, MBChB, MSc, et al
University of Manitoba, Winnipeg, Manitoba, Canada
http://www.annfammed.org/content/16/3/217
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