Did We Forget about Social Determinants of Health in Dermatology?
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ABSTRACT:
SUBMITTER: Christensen EMM
PROVIDER: S-EPMC10811546 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
Publications
Did We Forget about Social Determinants of Health in Dermatology?
Christensen Elisabeth M M EMM Jemec Gregor B E GBE
Acta dermato-venereologica 20240122
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Project description:BackgroundMany women's shelters across the nation have programs that emphasize and empower women through career workshops and skills training. However, what is not typically addressed is their dermatological and mental health needs, which are equally important.ObjectiveThrough this pilot project, we aim to address the diverse interrelated issues concerning the whole woman and her body/mind systems including skin cancer awareness, skincare, healthy sun habits, self-esteem, mental health, and stress management. By addressing the woman holistically, we hope to positively impact the way she views and values herself.MethodsWe partnered with a local women's shelter to host a seminar focused on dermatological and mental health education. Pre- and post-seminar surveys were collected from participants. Surveys were anonymous and aimed to evaluate the success and efficiency of the workshop to guide and improve future seminars. The seminar had three workshops: skin cancer and sun protection, skincare, and mental health and wellness. Upon completion of the seminar, the attendees were provided with the opportunity to receive free skin examinations by two board-certified dermatologists, and referrals were made to Northeast Ohio Medical University's Student-Run Free Clinic. Upon completion of the seminar, attendees were provided with items such as sunscreen, skincare, and mental health resources.ResultsThe "Skincare from the Inside Out" pilot project proved to be beneficial to residents of both Norma Herr Women's Shelter.LimitationsLimitations of this study were the small sample size (n = 15), due to participation limitations during the COVID-19 pandemic.ConclusionUltimately, to reduce the morbidity and mortality of dermatologic conditions associated with homelessness, it is imperative to address upstream social determinants of health. Future development of this pilot project will aim toward educating medical professionals on the unique and complex dermatologic and mental health needs of women experiencing homelessness.
| S-EPMC10424894 | biostudies-literature
Project description:BackgroundDespite the acknowledgment of the importance of social determinants of health (SDOH) on clinical outcomes, few clinical trials provide information about SDOH. Including these markers in pediatric dermatologic clinical trials may lead to improved care and novel observations about the disease.ObjectiveUsing a systematic review, assess the use of SDOH in pediatric dermatology clinical trials.MethodsCINAHL Plus, Cochrane: CENTRAL, Embase, PubMed, and Scopus were searched. English language randomized controlled trials about pediatric dermatology diseases published from January 2011 to May 2022 were included. Two authors independently screened all records using Covidence at 2 levels. Two authors independently collected data using Covidence and Microsoft Excel and assessed study quality. A protocol was registered at Open Science Framework: https://doi.org/10.17605/OSF.IO/B93VY.ResultsA total of 6463 records were retrieved and 4298 were screened at title/abstract. Next, 1738 records were screened at full text and 1085 were included. Of these, 119 reported an SDOH factor for a pediatric dermatology disease. Income or socioeconomic status was the factor most reported followed by social support, location, and health insurance. Most of the studies were conducted outside of the United States.LimitationsThere are a limited number of dermatology clinical trials that include a pediatric population.ConclusionDespite including over 1000 pediatric dermatology clinical trials, only 119 used SDOH. Pediatric dermatology researchers must prioritize including and reporting additional SDOH in clinical trials if the goal is to impact and improve clinical care and innovate for diverse populations of patients.
| S-EPMC11332763 | biostudies-literature
Project description:Increasing evidence supports the idea that social determinants of health, e.g., educational attainment, employment, and community context, directly affect health status. Researchers are also beginning to explore the impact of social factors on skin diseases, though no formalized research field, to the authors' knowledge, provides a structured framework for such practice. In this article, the novel global research field of "Social Dermatology" is introduced to structure academic knowledge in dermatology. The aim is to outline how this paradigm shift could transform both clinical practice and scientific research. The field will explore subjects studied within the medical field of Social Medicine, adapting and applying them to the context of dermatology. Specifically the article will address the social determinants of health in dermatology, and elaborate on human functioning as an approach to a more comprehensive understanding of health in people with skin diseases. This approach enables the integration of rehabilitative aspects, with the International Classification of Functioning (ICF) guiding research and clinical practice to promote more equitable and patient-centred care. To address methodological and communicative opportunities it is suggested that a theoretical web-based social incubator be developed. A formal agreement on the values, interests, and challenges of this new field is needed for a sustainable research effort.
| S-EPMC11898108 | biostudies-literature
Project description:This work is an implementation science study that examines different aspects of implementing a single intervention. The intervention consists of asking community health centers to implement an outreach strategy to screen patients for colorectal cancer and for social determinants of health in community health centers at the same contact point. These are both clinical targets that the CHCs feel that their patients need and want to offer at a higher rate. The intervention consists of outreach to patients in need of colorectal cancer screening (CRC) to offer fecal immunochemical test (FIT) screening and screening for social determinants of health (SDOH). In this implementation science study, the intervention is an evidence-based intervention being implemented in real-world clinical practice. The intervention is the outreach to offer FIT and SDOH, conducted by clinic staff. Both evidence-based screening activities-FIT and SDOH screening-are used in the practices included in the study but pairing them is intended to increase efficiency and patient-centeredness by addressing health related social needs that may impact patients’ ability to engage in cancer screening. The study aims to test the effect of implementing the intervention on clinical and process outcomes. Clinical outcomes are CRC screening and SDOH screening. Analysis of process outcomes includes measuring what organizational factors influence implementation.
| 2354406 | ecrin-mdr-crc
Project description:As the articles in this Supplement demonstrate, the social determinants of health are a major focus for Kaiser Permanente and the broader US health care system. Mounting evidence of the impact of social determinants on people’s health has stimulated a surge of activity among policymakers, health systems, and a growing number of social entrepreneurs to integrate health and social services and to find novel ways to finance those efforts. The question is no longer whether there is an appropriate role for the US health care system in addressing the social determinants of health, but what that role is, how to create the right policy context for innovation and how health care can partner more effectively with providers of social services to meet patients’ most pressing needs given the fragmented, typically underresourced nature of the social sector.
| S-EPMC6207436 | biostudies-other
Project description:Background/Objectives: To describe social and psychological needs, such as poverty, early trauma, or adverse childhood events, of caregivers with a child newly diagnosed with cerebral palsy (CP) or receiving a designation of high-risk for cerebral palsy (HRCP). Methods: Caregiver self-report questionnaires screening for unmet social needs, adverse childhood experiences (ACEs), depression symptoms, and trauma were collected from 97 caregivers of children with CP/HRCP seen in a high-risk infant follow-up clinic (adjusted age range 1-24 months). We compared their responses to those of 97 caregivers of age-matched controls seen in the same clinic with similar risk factors over the equivalent time period. Results: Income insecurity and positive screening rate for depressive and trauma symptoms were high for both groups (CP/HRCP, matched control group); no differences were found between CP/HRCP and control groups. Rates of food and housing insecurity and caregiver ACEs were not different between groups. All families received referrals to appropriate community support at the visit. Conclusions: Caregivers of children with CP/HRCP in high-risk infant follow-up clinics may face difficult conversations and decision-making in the context of high psychological and social adversity. Comprehensive support should be considered as early as possible.
| S-EPMC11642413 | biostudies-literature
Project description:A full understanding of the role of the urban environment in shaping the health of populations requires consideration of different features of the urban environment that may influence population health. The social environment is key to understanding the way in which cities affect the health of populations. Social determinants of health (SDH) are important, generally, yet can have different effects in different settings from urban to rural, between countries, between cities, and within cities. Failure to acknowledge, and more importantly, to understand the role of SDH in health and access to health and social services will hamper any effort to improve the health of the population. In this paper, we will briefly summarize a few key SDH and their measurement. We will also consider methodologic tools and some methodologic challenges. The concepts presented here are broadly applicable to a variety of settings: developed and developing countries, slum areas, inner cities, middle income neighborhoods, and even higher income neighborhoods. However, our focus will be on some of the more vulnerable urban populations who are most profoundly affected by SDH.
| S-EPMC1891644 | biostudies-other
Project description:BackgroundVeterans Health Administration (VHA) is committed to providing high-quality care and addressing health disparities for vulnerable Veterans. To meet these goals, VA policymakers need guidance on how to address social determinants in operations planning and day-to-day clinical care for Veterans.MethodMEDLINE (OVID), CINAHL, PsycINFO, and Sociological Abstracts were searched from inception to January 2017. Additional articles were suggested by peer reviewers and/or found through search of work associated with US and VA cohorts. Eligible articles compared Veterans vs non-Veterans, and/or Veterans engaged with those not engaged in VA healthcare. Our evidence maps summarized study characteristics, social determinant(s) addressed, and whether health behaviors, health services utilization, and/or health outcomes were examined. Qualitative syntheses and quality assessment were performed for articles on rurality, trauma exposure, and sexual orientation.ResultsWe screened 7242 citations and found 131 eligible articles-99 compared Veterans vs non-Veterans, and 40 included engaged vs non-engaged Veterans. Most articles were cross-sectional and addressed socioeconomic factors (e.g., education and income). Fewer articles addressed rurality (N = 20), trauma exposure (N = 17), or sexual orientation (N = 2); none examined gender identity. We found no differences in rural residence between Veterans and non-Veterans, nor between engaged and non-engaged Veterans (moderate strength evidence). There was insufficient evidence for role of rurality in health behaviors, health services utilization, or health outcomes. Trauma exposures, including from events preceding military service, were more prevalent for Veterans vs non-Veterans and for engaged vs non-engaged Veterans (low-strength evidence); exposures were associated with smoking (low-strength evidence).DiscussionLittle published literature exists on some emerging social determinants. We found no differences in rural residence between our groups of interest, but trauma exposure was higher in Veterans (vs non-Veterans) and engaged (vs non-engaged). We recommend consistent measures for social determinants, clear conceptual frameworks, and analytic strategies that account for the complex relationships between social determinants and health.
| S-EPMC6153229 | biostudies-literature
Project description:Social determinants of health (SDOHs) mediate outcomes of critical illness. Increasingly, professional organizations recommend screening for social risks. Yet, how clinicians should identify and then incorporate SDOHs into acute care practice is poorly defined. How do medical ICU clinicians currently operationalize SDOHs within patient care, given that SDOHs are known to mediate outcomes of critical illness? Using ethnographic methods, we observed clinical work rounds in three urban ICUs within a single academic health system to capture use of SDOHs during clinical care. Adults admitted to the medical ICU with respiratory failure were enrolled prospectively sequentially. Observers wrote field notes and narrative excerpts from rounding observations. We also reviewed electronic medical record documentation for up to 90 days after ICU admission. We then qualitatively coded and triangulated data using a constructivist grounded theory approach and the Centers for Disease Control and Prevention Healthy People SDOHs framework. Sixty-six patients were enrolled and > 200 h of observation of clinical work rounds were included in the analysis. ICU clinicians infrequently integrated social structures of patients' lives into their discussions. Social structures were invoked most frequently when related to: (1) causes of acute respiratory failure, (2) decisions regarding life-sustaining therapies, and (3) transitions of care. Data about common SDOHs were not collected in any systematic way (eg, food and housing insecurity), and some SDOHs were discussed rarely or never (eg, access to education, discrimination, and incarceration). We found that clinicians do not incorporate many areas of known SDOHs into ICU rounds. Improvements in integration of SDOHs should leverage the multidisciplinary team, identifying who is best suited to collect information on SDOHs during different time points in critical illness. Next steps include clinician-focused, patient-focused, and caregiver-focused assessments of feasibility and acceptability of an ICU-based SDOHs assessment.
| S-EPMC11375804 | biostudies-literature
Project description:ImportanceUS health expenditures have been growing at an unsustainable rate, while health inequities and poor outcomes persist. Targeting social determinants of health (SDOH) may contribute to identifying and controlling health care expenditures.ObjectiveTo determine whether SDOH are associated with US health care expenditures by Medicare, Medicaid, and private insurers.Design, setting, and participantsCross-sectional study of adults, representing the US civilian, noninstitutionalized population with Medicare, Medicaid, or private coverage, from the 2021 Medical Expenditure Panel SDOH Survey. Data analysis was conducted from October 2023 to April 2024.ExposureSDOH as individual-level, health-related social needs categorized by Healthy People 2030 domains: (1) educational access and quality, (2) health care access and quality, (3) neighborhood and built environment,(4) economic stability, and (5) social and community context.Main outcomes and measuresThe primary outcome was health care expenditures (US dollars) by Medicare, Medicaid, and private insurers. A 2-part econometric model (probit regression model and generalized linear model with gamma distribution) was used.ResultsAmong the 14 918 insured adults in the analytic sample (mean [SD] age, 52.5 [17.9] years; 8471 female [56.8%]), the majority had middle to high family income (10 524 participants [70.5%]) and were privately insured (10 227 participants [68.5%]). Annual median (IQR) expenditure was $1648 ($389-$7126) for Medicaid, $3643 ($1321-$10 519) for Medicare, and $1369 ($456-$4078) for private insurers. Educational attainment and social isolation were associated with Medicaid expenditures. Medicaid beneficiaries with a high school diploma or general educational development certificate had on average (mean difference) $2245.39 lower annual Medicaid expenditures (95% CI, -$3700.97 to -$789.80) compared with beneficiaries with less than high school attainment. Compared with those who never felt isolated, Medicaid beneficiaries who often felt isolated had on average $2706.94 (95% CI, $1339.06-$4074.82) higher annual Medicaid expenditures. Health care access, built environment, and economic stability were associated with Medicare expenditures. Medicare beneficiaries living in neighborhoods with lower availability of parks had on average $5959.27 (95% CI, $1679.99 to $10 238.55) higher annual Medicare expenditures. Medicare beneficiaries who were very confident in covering unexpected expenses had on average $3743.98 lower annual Medicare expenditures (95% CI, -$6500.68 to -$987.28) compared with those who were not confident. Medical discrimination and economic stability were associated with private expenditures. Private insurance beneficiaries who experienced medical discrimination had on average $2599.93 (95% CI, $863.71-$4336.15) higher annual private expenditures compared with those who did not. Private beneficiaries who were contacted by debt collections in the past year had on average $2033.34 (95% CI, $896.82 to $3169.86) higher annual private expenditures compared with those who were not contacted.Conclusions and relevanceIn this cross-sectional study of 14 918 insured adults, individual-level SDOH were significantly associated with US health care expenditures by Medicare, Medicaid, and private insurers. These findings may inform health insurers and policymakers to incorporate SDOH in their decision-making practices to identify and control health care expenditures, advancing health equity.
| S-EPMC11581502 | biostudies-literature