A person with several dependent children has difficulty paying the rent and is afraid of being evicted. The most common is that he has insomnia, if not anxiety. They may prescribe medication, but the problem will persist. Medicine should not focus on the disease, but on the patient.
Health is strongly mediatized – by more than 80%, according to some studies – by the so-called social determinants of health (DSS). These are living conditions that should appear in the digital clinical history so that health professionals can take them into account when making a diagnosis or monitoring a patient. For five years, a team of professionals has developed a guide to DSS in primary care consultations with the aim of encouraging and facilitating their registration in patient records, which is currently not done as often as needed.
“Health is not the absence of disease, as described by the WHO, but a whole. DSS are not a disease, but healthcare professionals must take them into account because they influence the person’s state of health”, explains Berta Rodoreda, a nurse at CAP Santpedor who has led the research for the implementation of the tool that will facilitate the registration of DSS. “It is a very necessary and valuable instrument to be able to identify the needs of the people who are visited and promote comprehensive and holistic care by complementing the clinical assessment with the social assessment at the CAP”.
According to Rodoreda, outpatient clinics are the ideal level for codifying DSS: “We, the medical staff, nurses, social workers, know the lives of the people in front of us”. The researchers have published in the magazine Atención Primaria an evaluation of the results of the application of the DSS coding guide that has been carried out in the 32 primary teams of the ICS of Central Catalonia, which demonstrate its effectiveness in the daily workflow of professionals.
The guide includes 17 DSS (modifiable), such as education, social environment, work or unemployment, financial and housing circumstances, family circumstances and difficulties in managing life. The conditions that have been recorded most in the evaluation made by the outpatients have been the unwanted loneliness and the financial difficulty to make ends meet. They are precisely the most prevalent DSS, according to the WHO.
According to the researchers, despite the importance of recording DSS in the electronic clinical record in terms of improvements in health and reductions in social disparities, “professionals tend to record, in most cases, only clinical diagnoses” . But during the test of the new guide in the CAPs there was an increase in both the number of DSS registrations and the number of professionals registering them. “In the same way, the professionals expressed the need to have this social vision that is so necessary to be able to attend holistically to the person who consults and to be able to offer adequate treatment”, the work indicates.
“This guide is the beginning of many things, the first step”, says Rodoreda. “It must facilitate a more personalized, more valuable care, taking into account all the patient’s conditions and, on the other hand, it will be useful for the administrations when it comes to having photographs of different situations in neighborhoods, communities, municipalities or regions and learn about their most prevalent health determinants”.
As part of the action plan for primary and community care, the Ministry of Health, in competition with the autonomous communities, is preparing a document on “the social determinants and the family context that would be advisable to include in the digital health history ” with the aim of homogenizing the criteria, encouraging registration and promoting the biopsychosocial approach from the consultation.
