Social Determinants in Wound Management

Click here for a related article.

Windy Cole, DPM, CWSP, FACCWS: I'd say the top two biggest social determinants of health are socioeconomic status and education level and those two are very much linked, right?
 
Studies have shown that if you are in the lower tier for social economic status, you at a disadvantage, you may not be insured or you might be underinsured. You might not have access to specialists. I've traveled around the country. I was in very rural South Dakota, the end of last year, and there is a wound care center where people travel over two hours to get to because it's the only one in the region. So that's a problem. It's a problem because to have a patient go there regularly for care is a huge obstacle. Education also factors in that too.
 
Of course, the lower your education level, probably the less likely you are to have a job that pays a significant amount or offers you insurance. And there are studies that actually show that people with just a high school education actually have a chronologic age that is eight years older than their counterparts that have a college degree. And those folks with a lower education level actually participate in bad activities like smoking and other things and limit activity levels. And we know those are bad events that could lead to comorbidities, non-healing wounds, and lack of good health.
 
What should physicians consider with patients who may have health care disparities?
 
I think we really need to start focusing on patient-centered factors. We talked about looking at the patient's comorbidities, their medications, assessing the wound, but really assessing patient factors such as what is their home environment like?
 
How is their ability to have transportation? What is their social network? That's another thing that contributes to disparity. Are they isolated? Do they have family members that they can rely on? That's a huge key. What are their religious beliefs? What is their ethnicity?
 
And what is their race? And how does it affect how they interact with their clinicians? And having clinicians that come from a wide variety of walks of life is also important. When patients recognize themselves in their healthcare practitioner, they feel more comfortable and they might be able to relate, hey, I can't afford my medication. I'm only taking this medication once a week because I can't afford to renew the prescription because it's very costly. Or I really want to be compliant with your care, but I can't afford that dressing or I can't afford that copay. But making them comfortable is really on us as clinicians. And understanding what specifics are related to our local patient population? I mean, practicing in inner city LA is going to be different than rural Arkansas. And so what are the factors that are facing that population and getting to know your patient and being part of the community, I think is super important.
 
How can physicians overcome social determinant factors in health care?

I think we don't leverage social services as much as we could or should. Learning what resources are available in your area for patients that might have limited resources on their own is key. And partnering with case managers, be it a case manager at your local hospital facility or a case manager within an insurance company. I found that to be so helpful. I've had patients that just can't have transportation to a wound clinic once a week. But then if you call the insurance and talk to their case manager, they can get a voucher for a taxi or for Uber or even some of these health plans have their own driving services. And that's huge. Because if patients can't make it to their appointment and can't get their bandage changed or their debridements or whatever treatment we're using on them, we know that their wound care is going to be stalled. So really leveraging these local resources and partnering with them, I think, is really the first step for us to be successful.