Revolutionizing Patient Care: A New Framework for Addressing Social Determinants of Health
Understanding social determinants of health (SDH) and patients’ social circumstances is increasingly recommended for delivering contextualized care. However, the detailed processes of patient care related to SDH in clinical settings have largely remained undefined. This gap often leads to vague objectives and unclear assessment criteria in medical education, potentially undervaluing these crucial topics and even fostering misconceptions among trainees. Addressing this, the study by Mizumoto et al. introduces a groundbreaking framework designed to enhance medical education and improve the quality of patient care.
A Groundbreaking Consensus
This study presents a consensus of a variety of experts on the process observable practice activities (OPA) for patient care related to SDHs. Using a modified Delphi technique, the researchers gathered opinions from a diverse panel of 61 experts, ensuring comprehensive representation. This panel included clinical professionals (physicians, nurses, public health nurses, social workers, pharmacists, and medical clerks), residents, medical students, researchers (medical education, healthcare, sociology of marginalized people), support members for marginalized people, and even patients. This broad participation increases the panel’s diversity and strengthens the framework’s applicability.
The Communication–Practice–Maintenance–Advocacy (CPMA) Framework
The study identified 14 observable steps for patient care related to SDH, which are organized into four critical components: Communication, Practice, Maintenance, and Advocacy. The entire process emphasizes the importance of ongoing patient–physician relationships and collaboration with professionals and stakeholders.
- Communication: This component focuses on building a strong patient–physician relationship conducive to discussing the patient’s social background, actively listening to their life experiences, and engaging in shared decision-making processes. It also highlights the importance of discussing patient circumstances with other professionals and stakeholders to gain a multidimensional understanding and providing adequate explanation and support. The Delphi rounds revealed insights into the necessity for physicians to be aware of their own prejudices and biases that might impair patient-centeredness.
- Practice: This section illustrates the practical actions physicians can take, such as identifying and documenting social factors that affect patient health and behavior with consent. It outlines determining how and when to address these factors collaboratively, referring patients to appropriate resources, and evaluating interventions to develop subsequent plans. This component underscores the need for a longitudinal, comprehensive, and team-based approach, recognizing that complex social problems often require stabilization rather than quick resolution.
- Maintenance: A unique and crucial aspect of this framework, Maintenance addresses the well-being of healthcare professionals. It encourages physicians to verbalize feelings of moral distress (e.g., anger, sadness, helplessness) encountered when facing patients in difficult situations and to reflect on patient care details and their own emotions with other professionals and stakeholders. This can help mitigate burnout associated with addressing patients’ social needs.
- Advocacy: This component defines practical advocacy roles for physicians. It involves exploring and identifying challenges within the medical, nursing, and social care systems that impede patient access to care and treatment, and addressing them when possible. Physicians are also encouraged to explore and identify broader social inequities affecting patient health and participate in advocacy and action to reduce their effects. The study specifically demonstrated a consensus on the feasibility of these specific advocacy aspects for physicians in clinical settings, such as identifying access barriers within their own healthcare system.
Impact on Medical Education and Patient Outcomes
The CPMA framework provides explicit documentation of the expected achievements from SDH education. By clearly describing the process, it aims to reduce discomfort for learners facing complex challenges with low certainty, such as SDH, and offers a clear guide for clinical practice reflection and workplace-based assessment. This robust framework is poised to significantly improve medical education in SDH, potentially leading to enhanced quality of patient care and improved patient outcomes. Further research is needed to validate and explore its implementation in various contexts.
Reference for this article:
Mizumoto, J., Mitsuyama, T., Kondo, S., Izumiya, M., Horita, S., & Eto, M. (2023). Defining the observable processes of patient care related to social determinants of health. Medical Education, 57(1), 57–65. https://doi.org/10.1111/medu.14915
