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Social factors often have greater influence on patients' health than medical care. Identifying those factors is the first step to addressing them.

Fam Pract Manag. 2022;29(2):6-11

This content conforms to AAFP criteria for CME.

Author disclosure: no relevant financial relationships.

Having a clear picture of your patients' socioeconomic needs is key to improving their health outcomes. Lack of food, housing, clean water, transportation, and employment, among other challenges, can have significant downstream effects on otherwise healthy patients. For those with chronic conditions, socioeconomic factors are even more crucial because they hinder lifestyle changes that are often first-line treatments for those conditions. For example, patients with type 2 diabetes may be unable to control their A1C if they cannot afford their medications or do not have access to healthy groceries.

Non-medical conditions that significantly affect health and quality of life are called social determinants of health (SDOH). According to the U.S. Department of Health and Human Services, SDOH fall into five categories: economic stability, health care access and quality, education access and quality, neighborhood and built environment, and social and community context.1 Within these categories are basic needs such as safety, transportation, food, and housing.

The Robert Wood Johnson Foundation estimates social needs account for as much as 80% of health outcomes.2 If social needs are not met, physicians and other providers will be largely unable to improve outcomes. This is bad for patients, and makes it harder for physicians to succeed in value-based payment arrangements.3 Thus, identifying and addressing SDOH should be an integral part of family medicine practices.

But how do you have a meaningful conversation with your patient about SDOH during a 15-minute visit when other problems also need to be addressed? It starts with screening.

KEY POINTS

  • Social determinants of health (SDOH) can have a big impact on patient outcomes, so identifying and addressing them is key, especially as more payers move to value-based payment systems.

  • Several screening tools are available to help practices identify social needs and facilitate conversations with patients.

  • ICD-10 “Z” codes (Z55-Z65) can be used to document social determinants of health and give practices accurate data on the needs of their patient population.

WHY AND HOW TO SCREEN FOR SDOH

The rationale for SDOH screening is simple: If you don't ask, you won't know. And if you do not know about a patient's social needs, you cannot address them and provide the best care. You may be spinning your wheels trying to get a patient's blood pressure under control if you do not know that the patient is struggling with homelessness or unemployment, not simply making poor dietary choices or forgetting to take medication. Patients may not volunteer this information because they do not see the connection between SDOH and their health. This is why practices need to be proactive in assessing social needs. Screening for SDOH should be a routine part of patient registration, rooming, obtaining a social history, and seeing the patient.

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