CHICAGO — To give a sense of how social factors affect someone's health, Sarah Candler, MD, MPH, described this case: A 70-year-old woman with diabetes, rheumatoid arthritis, and high blood pressure and a high hemoglobin A1C, even though she's on insulin.
This patient is on prednisone for her RA because she can't afford better drugs, and she has been occasionally skipping her insulin, Candler said during her presentation, at the annual meeting of the American College of Physicians
Plus, her first language is Turkish, and she's missed many doctor appointments because she lives too far from the center-city clinics, said Candler, who is the care team medical director at Iora Primary Care in Houston.
How are this woman's needs supposed to be met in a fee-for-service system that allows medical staff 15 to 30 minutes to help solve her problems?
Potential Regulatory Fixes
A panel of experts talked about potential policies and regulatory fixes that take into account the impact of "social determinants of health." Some of these are gaining traction, but there is still a huge gap between how medicine in practiced in the United States and the health needs of people in the community, the panelists said.
The ACO REACH (Realizing Equity, Access and Community Health) model is a recent step forward, said Josh Liao, MD, MSc, associate chair for health systems at the University of Washington, Seattle.
