Unde rsta nding Ho w So c ia l De te rmina nts o f He a lth I mpa - PowerPoint PPT Presentation

Unde rsta nding Ho w So c ia l De te rmina nts o f He a lth I mpa c t Dia b e te s Ma na g e me nt: A RRNe T Study Ine z Cr uz, PhD, L MSW Ronya Gr e e n, MD, MPH, CPE Me r e dith Williamson, PhD

I mpa c t o f Unc o ntro lle d T ype I I Dia b e te s  30.3 millio n pe o ple a c ro ss the U.S.  11.4% o f T e xa s po pula tio n  Co st = $245 b illio n  F uture o f Ac c o unta b le Ca re Org a niza tio ns & Va lue -Ba se d Ca re

So c ia l De te rmina nts o f He a lth (SDo H) Ne ig hb o rho o d & Built E nviro nme nt E c o no mic He a lth & He a lthc a re Sta b ility SDo H So c ia l & Adapte d fro m He althy Pe o ple 2020 E duc a tio n Co mmunity http://www.he althype o ple .g o v/202 Co nte xt 0/to pic s-o b je c tive s/to pic /so c ial- de te rminants-o f-he alth

SDo H a nd Chro nic Dise a se Ma na g e me nt • E vide nc e tha t SDo H ha ve g re a te r influe nc e o n c hro nic dise a se ma na g e me nt tha n me dic a l c a re • Pa tie nt-Physic ia n He a lth Be lie fs https:/ / www.c dc .g o v/ so c ia lde te rmina nts/ inde x.htm • Dispa ritie s re la te d to SDo H

Dwye r-L indg re n e t al. “I ne q ualitie s in L ife E xpe c tanc y Amo ng US Co untie s, 1980 to 2014: T e mpo ral T re nds and Ke y Drive rs” JAMA Ne two rk (2017)

https:/ / www.c o untyhe althranking s.o rg / site s/ de fault/ file s/ state /do wnlo ads/2019%20He alth%20F ac to rs%20-%20T e xas_0.png

e xa s Re side nc y Re se a rc h Ne two rk o f T ) (RRNe T

 Missio n Sta te me nt  T o impr ove family physic ians’ skills and inte r e st in r e se ar c h, and t o find answe r s to c linic al que stions that ar e r e le vant to family me dic ine patie nts in T e xas.  Re se a rc h pro je c ts c o nduc te d in RRNe T a re drive n b y the inte re sts o f its me mb e rs.  RRNe T re se a rc h da ta a nd re se a rc h finding s b e lo ng to its me mb e rs.  All RRNe T me mb e rs who pa rtic ipa te in a study a re c o -inve stig a to rs a nd c o -a utho rs.

Re side nc y Re se a rc h Ne two rk o f T e xa s (RRNe T )  10 Pro g ra m Site s  120 fa mily physic ia n fa c ulty  Austin  Brya n  300 fa mily me dic ine re side nts  Co rpus Christi  Da lla s  300,000 pa tie nt visits/ ye a r  E dinb urg  F o rt Wo rth  Ha rling e n  L ub b o c k  Mc Alle n  Sa n Anto nio

o unda tio n Re se a rc h Gra nt P F AF T

Study Purpo se  T o e va lua te the impa c t o f So c ia l De te rmina nts o f He a lth (SDo H) o n Dia b e te s ma na g e me nt a nd de te rmine its a sso c ia tio n with dia b e te s o utc o me s a nd pro vide r a wa re ne ss.  T o me a sure the c o rre la tio n b e twe e n SDo H a nd dia b e te s ma na g e me nt; Dia b e te s Distre ss (DD), Dia b e te s Qua lity o f L ife (DQo L ) a nd dia b e te s ma na g e me nt.  T o me a sure the c o rre la tio n b e twe e n pro vide r a wa re ne ss a nd dia b e te s ma na g e me nt, DQo L , a nd DD

Study De sig n  Multi-site  Cro ss-se c tio na l study o f type -2 dia b e tic pa tie nts  3 ano nymo us surve ys: One fo r pa tie nts with dia b e te s, o ne fo r E MR da ta c o lle c te d, a nd o ne fo r pro vide rs.  8 we e ks o f da ta c o lle c tio n

https://ame ric anspc c .o rg /adve rse -c hildho o d-e xpe rie nc e s/

Study Re sults  7 site s pa rtic ipa te d in the study  Summe r – F a ll 2018  642 pa tie nt surve ys  370 pro vide r surve ys

o Answe r Othe r/ Pre fe r No t T 34% ndia n 18% Ame ric a n I 12% Asia n 1% 2% 33% Hispa nic thnic ity Bla c k E White

Hig he st E duc a tio n L e ve l 184 137 109 63 49 41 33 E DUCAT I ON L e ss tha n Hig h Sc ho o l Hig h Sc ho o l/ GE D So me Co lle g e Jr Co lle g e T e c hnic a l/ Vo c a tio na l Co lle g e / Ba c he lo r De g re e Gra dua te / Pro fe ssio na l Sc ho o l

E mplo yme nt Sta tus 2% F ull-time 21% Pa rt-time 30% Sta y a t Ho me / Ca re g ive r Re tire d 0% Une mplo ye d 7% Stude nt 5% Disa b ility 6% L iving o n F e de ra l Assista nc e 29%

My do c to r sho ws inte re st in my life , o utside o f my me dic a l he a lth. 284 205 60 33 Ye s, ve ry inte re ste d Ye s, so me wha t No , no t usua lly No , no t a t a ll inte re ste d inte re ste d inte re ste d

Ho w o fte n do yo u se e o r ta lk to pe o ple tha t yo u c a re a b o ut a nd fe e l c lo se to ? 400 350 300 355 250 200 150 100 97 95 55 50 0 L e ss tha n o nc e a Onc e to twic e T hre e to five time s Gre a te r tha n five we e k pe r we e k pe r we e k time s pe r we e k

Do yo u ha ve a ny c o nc e rns a b o ut sa fe ty in yo ur ne ig hb o rho o d? 18% No Ye s 82%

Pa tie nt-Pro vide r Co nc o rda nc e  Physic ia n a wa re ne ss o f pa tie nts’ e nviro nme nta l, so c ia l, a nd fina nc ia l sta tus  Ma y a lso inc lude a wa re ne ss o f pa tie nts’ he a lth b e lie fs  Ma jo r drive r o f pa tie nt c e nte re d c a re  Pre vio usly implic a te d in impro ve d o utc o me s

Co nc o rda nc e a nd Dia b e te s Outc o me s L owe r HbA1c , L DL F e we r Dise ase Complic ations (MI, amputations, CKD) F e we r Hospitalizations and Clinic Visits Highe r L e ve ls of Patie nt-Pr ovide r Conc or danc e : E duc ation L e ve l T r anspor tation Ne ighbor hood Safe ty F ood Se c ur ity Quality of L ife Soc ial Ne twor ks

Patie nt- HbA1c Dise ase Numbe r of Pr ovide r Complic ations Clinic Visits Conc or danc e (past ye ar ) E duc a tio n L e ve l Po sitive 4% * (MI ) Ne g a tive 10% T ra nspo rta tio n Sta tus Po sitive 20% * (CK D) 6.5 Ne g a tive 30% 7.7 Ne ig hb o rho o d Po sitive 22% * (CK D) Sa fe ty Ne g a tive 39% F o o d Se c urity Po sitive 8.03 * Ne g a tive 8.55 Qua lity o f L ife Po sitive 6.2* Ne g a tive 7.4 So c ia l Ne two rks Po sitive 7.8* 6.0** • * p<0.05 Ne g a tive 8.3 7.5 • * * p<0.01

Wha t Do e s L a c k o f Co nc o rda nc e Me a n?  Physic ia n  Histo ry T a king Skills  I mpa ire d T rust  I mpo ste r Syndro me  Pa tie nt  Sha me  F e a r o f Re je c tio n  I mpa ire d T rust

Wha t is Dia b e te s Distre ss (DD)?  DE F I NE D:  Dia b e te s Distre ss is the uniq ue , o fte n hidde n, E MOT I ONAL BURDE N tha t pe o ple with dia b e te s e xpe rie nc e whe n ma na g ing the ir c hro nic dise a se  DD = the wo rry c re a te d b y c o mple xity o f DM se lf ma na g e me nt  DD is CAUSE D b y fe e ling OVE RWHE L ME D witho ut c o ping skills, kno wle dg e , re so urc e s o r suppo rt syste ms

T he 4 Co mpo ne nts o f Dia b e te s Distre ss  E mo tio na l Burde n  F e e ling o ve rwhe lme d b y the de ma nds o f living with dia b e te s  Physic ia n Re la te d Distre ss  F e e ling s tha t the pro vide r is no t a ddre ssing yo ur c a re  I nte rpe rso na l Distre ss  F e e ling tha t o the r pe o ple do no t a ppre c ia te yo ur strug g le  Re g ime n re la te d Distre ss  F e e ling a s if yo u c a nno t a dhe re to the life style mo dific a tio ns  Re g ime n-re late d distre ss is the mo st c o mmo n c halle ng e fo r patie nts whic h why we didn’ t asse ss this

Pre va le nc e o f Dia b e te s Distre ss (DD)  Hig h le ve ls o f Dia b e te s Distre ss a re Co mmo n  Appro xima te ly 35% o f pa tie nts ha ve DD (lo w e stima te )  Pe rsists o ve r time  Do e s no t g o t a wa y b ut ra the r e b b s a nd flo ws  Hig h le ve ls o f DD a re a sso c ia te d with:  Po o r g lyc e mic c o ntro l, se lf-c a re , die t a nd q ua lity o f life  L o w dia b e te s se lf-e ffic a c y

Dia b e te s Distre ss a nd Dia b e tic Outc o me s Co mplic a tio ns o f Adva nc e d Dise a se Unc o ntro lle d DM Dia b e tic Distre ss

Re so urc e s to Addre ss Ne g a tive SDo H  Me dic a l T ra nspo rta tio n  L o c a l F o o d Ba c k  Ac c o unta b le Ca re Org a niza tio n So c ia l Se rvic e s  Aunt Be rtha  E le c tro nic Me dic a l Re c o rd