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    How physicians can overcome socioeconomic obstacles to improve adherence


    The more doctors are able to understand the challenges patients face in life, the more that can be used to create a positive attitude from both the doctor and the patient, he adds. “There is not a pill out there that is going to fix someone who doesn’t have enough food to eat.”

    Patients facing these challenges often are not in a position to help themselves, so physicians need to do part—and sometimes all—of the work to help them. Experts say to start by researching what resources exist for the social challenges a practice sees the most.

    “Connecting to resources in the community requires some initial effort, but many partnerships and activities are already underway,” says Bhatt, adding that reaching out to the public health department, local hospitals and social organizations is a good place to start. 


    Educating patients 

    Bryce says part of the role of the doctor is to educate patients on help that is available. For instance, Detroit has a program where food stamps can be used to buy double the face value of fresh fruits and vegetables. Many patients have access to the market, but just don’t know about it. He adds that education efforts aren’t always perfect, but putting patients in touch with the right resource can make a big difference.


    FURTHER READING: Are partnerships still worth it for physicians?


    Some patients will require more hand-holding than others, but Long says it’s often ineffective to just scratch out a name or phone number of a community resource on a slip of paper and hand it to the patient. “If you are in a small practice, I think you have to start sitting down with people doing the social services that work in the area and start networking in a meaningful way.” 

    Cunningham agrees, noting that time invested with a representative from a social service agency may yield a list of services and contacts for a variety of types of help. For those patients who need additional assistance, she suggests smaller practices try to identify local volunteers who could serve as a liaison between the practice and the social agencies, helping them fill out forms or setting up interviews.

     “Also, ask questions of your patients during the visit to identify issues that may have been missed—‘I’m writing a prescription now, do you have a way to pick it up and a way to pay?’” says Cunningham. A call to the pharmacy may reveal programs to help with adherence through medication reminders via text message or phone calls, but the practice may have to do some of the work on the patient’s behalf.

    Long says that his office practices a model where the patient is shown how to do something once, with the expectation the patient can do it the next time. For example, a patient needing transportation assistance would be given help filling out the application and getting the initial appointment set up. After that, about 80% of the patients have the knowledge to continue on their own.


    HOT TOPIC: Patients increasingly disrespectful of physicians


    “You have to meet the patient where they are at,” says Bryce. “For some patients, you can show them a program for free food and they take it from there, but for others, you have to take it step by step. You don’t always get the outcomes you want, but you just do the best you can.” 

    The trust established between the physician and the patient will also go a long way toward helping address any socioeconomic challenges the patient may face. The more the patient trusts the doctor, the more open he or she will be to receiving referrals to help them address their needs, says Bhatt.

    “Additionally, developing trusting relationships with community partners is also important,” he says. “In the partnership, practices should define roles and responsibilities and deliverables for each team member.”

    Checking up on patients after their consultation with social services can help patients feel connected and cared for, Bhatt adds.

    Addressing social determinants of health is not the job of one physician alone, but an effort must be made if patients are to overcome their challenges and if physicians are to maximize their reimbursement under value-based care.

    “Start off small, build resources and skills within your team to address these issues,” says Bhatt, “then start collaborating with other physicians, local community organizations, local businesses etc., to help the most prominent health needs in the community.” 

    Todd Shryock
    Todd Shryock, contributing author


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