Population Health: Proactive Solutions for Healthy Outcomes

Social environments contribute directly to a wide range of health outcomes. The social determinants of health refer to conditions in the environments in which people live, work, play, worship, and age. Traditionally, the public health sector factored the social determinants of health into practice, while the hospital sector focused on individual factors, such as illness and the provision of episodic curative services. However, health care in the US is evolving. These separate views are no longer sufficient, and population health is now considered the solution. Population health addresses the full range of the determinants of health and involves measuring and optimizing the health of groups by embracing the traditional social determinants of health as well as health care delivery. The purpose of this article is to provide an overview of population health, highlight examples of how it is taking shape in Hawai‘i, and discuss how the University of Hawaiʻi at Mānoa School of Nursing and Dental Hygiene (UHM SONDH) is preparing its graduate nursing students for new roles in population health in Hawaiʻi.

The full Spotlight on Nursing column can be viewed at this link.  

Advocacy, Social Determinants Must Be Part of Physician Training

During my medical school training, there was a brief mention of social determinants of health. We did not have dedicated curriculum and we were not taught to screen for societal issues. The American Medical Student Association and AAFP started my education on how societal issues and health policy ultimately affect the health of the public. From these "introductory courses," so to speak, I was inspired to pursue my Master of Public Health degree concurrent with my Doctorate of Osteopathic Medicine.

By being involved in these organizations and obtaining this additional graduate degree, my perspective of how medicine should be practiced and what additional skillsets a physician needs to learn changed. It became increasingly important to me that the next step of my training would include education in population health. So, I sought out a residency program where there was a focus on public health as it relates to physical health and well-being, and where I was given the opportunity to participate in activism on behalf of and alongside the patients I was seeing in office.

Had I not been a part of these medical organizations or trained at a residency program that teaches residents how systems of oppression and social factors of disease impact the lives of patients, I may have been yet another doctor who overlooked the actual cause of this patient's weight loss.

It is crucial that medical education integrate curricula around activism, advocacy and public health if we wish to truly train physicians to be able to take care of communities.

The full AAFP article can be viewed at this link.

How Algorithmic Empathy Will Improve Health Care

Recently, health care providers have started using artificially intelligent chat bots to guide patients through normal intake processes and other functions normally performed by staff. The bots can ask patients about basic symptoms, verify health insurance, and follow up after visits. They have the great potential to increase access and reduce costs for health care providers. But one of the key challenges to their successful adoption is maintaining patient engagement with these software robots; how do you get patients to talk to software robots about sensitive medical data? It turns out the answer is empathy.

The full Forbes article can be viewed at this link.  

Patients, clinicians and researchers working together to improve cardiovascular health: a qualitative study of barriers and priorities for patient-oriented research

In this study, research priorities were identified by patients and clinician-researchers working together to improve CV health. Future research programme and projects will be developed to address these priorities. A key output of this study is the creation of the patient advisory council that will provide support and will work with clinician-researchers to improve CV health.

The full article can be downloaded below.  

The value of healthcare data: to nudge, or not?

The processes of datafication, digitization and automation of healthcare and medicine are making new types and data available for analysis, and at greater volume. While the newly available data is often hailed as a solution to various problems in healthcare, there is only little discussion about who the use of such data empowers and who bears the costs. The use of healthcare data for “nudging”–e.g. to get patients to adopt healthier lifestyles–is a case in point: While such interventions are presumed to be cheap and effective, I argue that their value is a priori unclear. Both because of its assumed value-freeness, and because of its focus on individual behaviour, nudging draws attention away from the societal, political and economic factors that shape human practice. I conclude with a call upon policy makers to facilitate the use of healthcare data to build better institutions and to address social determinants of health before they seek to “fix” individual behaviour through nudging.

The full article can be viewed at this link.  

ZIP Code v. Genetic Code: How Health Plans Can Use Technology to Address the Social Determinants of Health

When it comes to the state of our health in the U.S., the playing field is anything but level.  

Study after study has shown that life circumstances, such as access to adequate food, education and healthcare, have a bigger impact on our health than our genetic makeup.

In other words, our healthcare destiny may depend more on our ZIP code than our genetic code.

The full Surescripts article can be viewed at this link.  

Prescription opioid misuse motive latent classes: outcomes from a nationally representative US sample

Prescription opioid misuse (POM) contributes to a larger opioid crisis in the US and Canada, with over 17 000 US POM-related overdose deaths in 2017. Our aims were to (1) identify specific profiles of respondents based on POM motives using the US National Survey on Drug Use and Health (NSDUH) and (2) compare profile respondents on sociodemographics, substance use and mental and physical health outcomes.

Analyses included 2017–18 NSDUH respondents with data on POM motives (n = 4810). POM was defined as prescription opioid use in a way not intended by the prescriber, including use without a prescription, in larger amounts or more frequently. Nine POM motives for the most recent episode were assessed, including ‘to relieve physical pain’ and ‘to get high’. Latent classes, based on POM motives, were estimated. Classes were compared on sociodemographics, substance use and physical and mental health outcomes.

Eight latent classes were identified (in order of prevalence): pain relief only, relaxpain relief, sleep-pain relief, multi-motive, high, experimenter, emotional coping and dependent/hooked. Compared to the pain relief only group, the high and multi-motive classes had higher odds of all substance use outcomes, with the dependent/hooked class having higher odds on all but one outcome. Six of the eight classes had higher odds of past-year mental health treatment and suicidal ideation than the pain relief only class.

Screening for pain, pain conditions, problematic substance use and psychopathology are recommended in those with any POM. While those in the dependent/hooked, multi-motive and emotional coping classes are most likely to have prescription opioid use disorder (OUD), screening for OUD symptoms in all individuals with POM is also warranted.

The full article can be downloaded below.

Suicide Rate Boosts Health Insurer Efforts To Curb Loneliness

The high U.S. suicide rate could embolden health insurer efforts to curb loneliness and address other social determinants that can lead to poor health outcomes and illnesses.

A new report Thursday from the Commonwealth Fund showed the U.S. having the “highest suicide rate of any wealthy nation.” U.S. suicides account for 14 deaths for every 100,000 people, or double the rate of the United Kingdom as one example, according to the Commonwealth Fund report, which compared the U.S. to 10 other “high-income nations” in the Organization for Economic Cooperation and Development.

The rising suicide rate comes as the U.S. spends a much higher amount on healthcare services per capita than these other wealthy countries. And it’s another sign that the U.S. “can do better, and … should start by assuring everyone can get the care they need, when they need it,” Commonwealth Fund president Dr. David Blumenthal said.

The full Forbes article can be viewed at this link.

Who Are the Key Players in Social Determinants of Health Strategy?

The healthcare industry has come to a consensus that the social determinants of health and population health are essential considerations for delivering on value-based care. But it takes a village, as the adage says, and organizations need to anticipate a number of stakeholders for making these programs a reality.

SDOH programs are inherently multi-stakeholder — they require the medical provider who will identify high-risk patients, fund sources, care coordinators or caseworkers, and the community-based partners that will help carry out interventions. Each of these stakeholders needs to be working in the same direction in order for programs to be successful.

The full Patient Engagement HIT article can be viewed at this link.  

When Insurance Won't Cover Drugs, Americans Make 'Tough Choices' About Their Health

The majority of Americans have health insurance that includes coverage for prescription drugs. But unfortunately that doesn't ensure that they can afford the specific drugs their doctors prescribe for them.

In fact, many Americans report that their insurance plans sometimes don't cover a drug they need — and nearly half the people whom this happens to say they simply don't fill the prescription. That's according to a poll released this month on income inequality from NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

The full NPR article can be viewed at this link.