Social Drivers of Health: Insights into addressing socioeconomic obstacles with patients

Susan Harriger: ©CareAllies

Providers who are familiar with the acronym SDOH commonly equate it with the phrase “social determinants of health.” Recently, however, a dialogue about the word “determinants” has arisen across the industry.

Some worry that the word “determinants” suggests that the socioeconomic factors it represents are predetermined and fixed—that there is not much anyone can do about their impact on health outcomes. Therefore, the word “drivers” is increasingly being recommended as an alternative.

The change is subtle but empowering. While it’s true that SDOH has a profound impact on patient health outcomes regardless of whether it stands for social determinants of health or social drivers of health, the word “drivers” implies the possibility of intervention. Providers who embrace the concept of “drivers” likewise accept the idea that socioeconomic factors are just as actionable a part of health care as clinical influences.

Old habits may die hard, and shifting the SDOH vernacular may entail ongoing debate and deliberation that some may argue won’t change anything. But, for providers and patients alike, talking about social drivers of health may help us think differently about how we approach them. It opens new opportunities to build a sturdy bridge between SDOH and clinical outcomes.

Building the bridge

Ideally, providers should consider SDOH and clinical outcomes as one conversation rather than two separate initiatives. After all, it is difficult to examine SDOH without considering the influence SDOH gaps have on clinical outcomes. Similarly, we can't talk about clinical outcomes without talking about the barriers to care that SDOH create.

For example, to improve health outcomes for patients with diabetes, providers should discuss SDOH obstacles (such as medication affordability) with patients while discussing their care plan and the importance of adherence. Although it might be considered a clinical issue if a patient doesn’t fill their insulin prescription, the reason why the patient isn’t filling their prescription may involve financial insecurity, lack of transportation, or other social drivers. Without understanding the drivers of these behaviors, it is difficult to encourage change.

That’s not to suggest that every patient is prepared to talk about socioeconomic issues like housing or food insecurity with their health care providers. Most patients today are used to only discussing clinical matters with their providers. Nevertheless, the majority of patients who participated in a Kaiser Permanente survey said they believed that their providers should ask about their SDOH needs—and help address them, too.

So, the SDOH tide may be turning. The more providers bring SDOH to the forefront of clinical conversations, the more comfortable and confident patients may become talking about it—and vice versa. However, such conversations are very personal, and some patients may be reluctant to tell a physician that they’re struggling to pay the rent, find healthy food, afford their prescriptions, etc. Therefore, it is vital that providers be able to identify those who could benefit from SDOH interventions, as well as encourage open SDOH conversations.

Identifying SDOH indicators

It is never safe to assume that patients don’t face SDOH barriers just because they don’t appear to have concerns or voice any difficulties. Some patients may simply be uncomfortable asking for help. Therefore, it’s important for providers to have ways to identify patients who may benefit from SDOH discussions. To recognize potential indicators that a patient is being affected by SDOH, providers can look for clues. Some examples include patients who:

• have frequent hospital admissions, readmissions, or emergency room visits
• are not self-managing their prescribed plan of care
• are at risk for falls
• show signs of being stressed and/or depressed.
• live in a disadvantaged community

In addition to proactively identifying potential SDOH barriers, providers can also encourage an environment in which they and their patients feel comfortable discussing SDOH. These discussions can uncover additional clues such as patients who:

• have financial, housing, and/or food insecurity
• lack transportation
• have limited social support
• need support from a caregiver or need assistance with the upkeep of their home
• have little experience/knowledge accessing community resources

Cultivating a trusted environment

There is no one-size-fits-all approach to creating a safe and empathetic environment where patients feel they can open up about SDOH concerns. Providers must tailor their approach based on their unique patient populations, but here are a few tips they can use to ease any discomfort and openly engage in SDOH conversations:

●Tip 1: Ask open-ended questions, instead of questions that result in a yes or no answer.

●Tip 2: Invite patients to discuss SDOH topics but respect their right to decide what information they want to disclose. For example, providers can state, “I’m happy to talk about all kinds of things, including your living situation and financial situation if you’d like to share.”

●Tip 3: Be knowledgeable about groups who may face greater demands, but do not make assumptions about those individuals’ life contexts.

●Tip 4: Make sure patients understand what you are asking and why you are asking it.

The integration of SDOH initiatives into clinical care is an ongoing shift that is gaining momentum. By merging SDOH and clinical discussions, health care providers can offer more comprehensive and tailored care to their patients. Encouraging open dialogues about SDOH indicators and cultivating a supportive environment for these conversations can lead to improved patient outcomes and a deeper understanding of the multifaceted factors influencing health. As providers continue to prioritize SDOH considerations in their practice, patients may feel more empowered to address their social needs, fostering a more holistic approach to health care delivery.

Susan Harriger, RN, MSW, LSW, CCM, is the Clinical Program Manager at CareAllies.