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)

SDo H

Ne ig hb o rho o d & Built E nviro nme nt

He a lth & He a lthc a re So c ia l & Co mmunity Co nte xt

E duc a tio n E c o no mic Sta b ility

Adapte d fro m He althy Pe o ple 2020 http://www.he althype o ple .g o v/202 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

• 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

• Dispa ritie s re la te d to

SDo H

https:/ / www.c dc .g o v/ so c ia lde te rmina nts/ inde x.htm

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

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

 Missio n Sta te me nt

 T

• impr
• ve family physic ians’ skills and inte r

e st in r e se ar c h, and to 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  Austin  Brya n  Co rpus Christi  Da lla s  E

dinb urg

 F

• rt Wo rth

 Ha rling e n  L

ub b o c k

 Mc Alle n  Sa n Anto nio  120 fa mily physic ia n fa c ulty  300 fa mily me dic ine re side nts  300,000 pa tie nt visits/ ye a r

T AF P F

• unda tio n Re se a rc h Gra nt

Study Purpo se

 T

• 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

• 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

• 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

E thnic ity

34% 18% 33% 2% 1% 12%

White Bla c k Hispa nic Asia n Ame ric a n I ndia n Othe r/ Pre fe r No t T

• Answe r

Hig he st E duc a tio n L e ve l

109 184 137 41 33 63 49

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

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

My do c to r sho ws inte re st in my life ,

• utside o f my me dic a l he a lth.

Ye s, ve ry inte re ste d Ye s, so me wha t inte re ste d No , no t usua lly inte re ste d No , no t a t a ll inte re ste d

284 205 60 33

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 ?

50 100 150 200 250 300 350 400

L e ss tha n o nc e a we e k Onc e to twic e pe r we e k T hre e to five time s pe r we e k Gre a te r tha n five time s pe r we e k

55 95 97 355

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% 82%

Ye s No

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

• utc o me s

Co nc o rda nc e a nd Dia b e te s Outc o me s

L

• we 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

• vide r

Conc or danc e : E duc ation L e ve l T r anspor tation Ne ighbor hood Safe ty F

• od Se c ur

ity Quality of L ife Soc ial Ne twor ks

Patie nt- Pr

• vide r

Conc or danc e HbA1c Dise ase Complic ations Numbe r

• f

Clinic Visits (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 Sa fe ty Po sitive 22% * (CK D) Ne g a tive 39% F

• 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** Ne g a tive 8.3 7.5

• * p<0.05
• * * 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

• 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

Dia b e tic Distre ss Unc o ntro lle d DM

Co mplic a tio ns o f Adva nc e d Dise a se

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

• c a l F
• 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

Re fe re nc e s

1. Sta tistic s Ab o ut Dia b e te s. Ame ric a n Dia b e te s Asso c ia tio n. http:/ / www.dia b e te s.o rg / dia b e te s- b a sic s/ sta tistic s/ . Upda te d July 19, 2017. Ac c e sse d F e b rua ry 28, 2018. 2. Dia b e te s Da ta : Surve illa nc e a nd E va lua tio n. T e xa s De pa rtme nt o f Sta te He a lth Se rvic e s we b site . https:/ / www.dshs.te xa s.g o v/ dia b e te s/ tdc da ta .shtm. T e xa s Dia b e te s a nd Pre dia b e te s F a c t She e t. Upda te d Se pte mb e r 2017. Ac c e sse d F e b rua ry 28, 2018. 3. Ca lc ula te Wha t Dia b e te s Co sts Yo ur Busine ss. Ce nte rs fo r Dise a se Co ntro l (CDC) a nd Pre ve ntio n we b site . https:/ / www.c dc .g o v/ dia b e te s/ dia b e te sa two rk/ pla n/ c o sts.html. Upda te d De c e mb e r 29, 2016. Ac c e sse d F e b rua ry 28, 2018. 4. So c ia l De te rmina nts o f He a lth. Wo rld He a lth Org a niza tio n we b site . http:/ / www.who .int/ so c ia l_de te rmina nts/ sdh_de finitio n/ e n/ . Upda te d 2018. Ac c e sse d F e b rua ry 28, 2018. 5. Willia ms DR, Co sta MV, Odunla mi AO, Mo ha mme d SA. Mo ving upstre a m: ho w inte rve ntio ns tha t a ddre ss the so c ia l de te rmina nts o f he a lth c a n impro ve he a lth a nd re duc e dispa ritie s. J Pub lic He alth Manag Prac t. 2008;14(Suppl):S8-17. 6. Wo o lf SH, Jo hnso n RE , Phillips RL , Philipse n M. Giving e ve ryo ne the he a lth o f the e duc a te d: a n e xa mina tio n

• f whe the r so c ia l c ha ng e wo uld sa ve mo re live s tha n me dic a l a dva nc e s. Am J Pub lic He alth.

2007;97(4):679-683. 7. Stre e t RL Jr., Ha ide t P. Ho w we ll do do c to rs kno w the ir pa tie nts? F a c to rs a ffe c ting physic ia n unde rsta nding

• f pa tie nt’ s he a lth b e lie fs. J Ge n I

nte rn Me d. 2010;27(1):21-27. 8. Huffhine s L , No se r A, Pa tto n SR. T he link b e twe e n a dve rse c hildho o d e xpe rie nc e s a nd dia b e te s. Curr Diab Re p. 2016;16(6):54. 9. L ib urd L C, Ja c k L Jr., Willia ms S., T uc ke r P. I nte rve ning o n the so c ia l de te rmina nts o f c a rdio va sc ula r dise a se a nd dia b e te s. Am J Pre v Me d. 2005;29(5)(suppl 1):18-24. 10. Bra nc a ti F L ., Whe lto n PK , K ulle r L H, K la g MJ. Dia b e te s me llitus, ra c e , a nd so c io e c o no mic sta tus a po pula tio n-b a se d study. Ann E pide mio l.1996;6(1):67-73. 11. E ve rso n SA, Ma ty SC, L ync h JW, K a pla n GA. E pide mio lo g ic a l e vide nc e fo r the re la tio nship b e twe e n so c io e c o no mic sta tus a nd de pre ssio n, o b e sity, a nd dia b e te s. J Psyc ho so m Re s. 2002;53(4):891-895.