A person, with several dependent children, has difficulty paying the rent and fears eviction. The most normal thing is for her to suffer from 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 mediated – more than 80% according to some studies – by the so-called social determinants (DSS). These are living conditions that should appear in the 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 in order to encourage and facilitate their recording in the digitalized history of patients.
“Health is not the absence of disease, as described by the WHO, but rather a whole. DSS are not a disease in themselves, but health professionals must keep them in mind 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 DSS registration. “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, complementing the clinical assessment with the social assessment in the CAP.”
According to Rodoreda, outpatient clinics are the ideal level to codify the DSS: “We, the medical staff, nurses, social workers, know the lives of the people in front of us.” The researchers have published in the journalCare Primary an evaluation of the results of the application of the DSS coding guide in the 32 primary teams of the ICS of Central Catalonia, which demonstrate its effectiveness in the daily workflow of professionals. .
The guide contains 17 DSS (changeable), such as education, social environment, work/unemployment, economic and housing circumstances, family circumstances or difficulties in managing life. The conditions most recorded in the evaluation carried out by the outpatient clinics were unwanted loneliness and financial difficulty in making 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 medical record in terms of improvements in health and reductions in social disparities, “professionals tend to record, in most cases, only the diagnoses clinical”. But in the test of the new guide in the CAPs there was both an increase in the number of DSS registrations and the number of professionals registered. “Likewise, professionals expressed the need to have this social vision that is so necessary to be able to holistically care for the person who consults and be able to provide adequate treatment,” the work states.
“This guide is the beginning of many things, the first step,” says Rodoreda. “It should facilitate more personalized, more valuable care, taking into account all the patient’s conditions and, on the other hand, it will be useful for administrations when taking photographs of neighborhoods, communities, municipalities or regions and knowing their determinants for the most prevalent health”. Within the framework of the Primary and Community Care Action Plan, the Ministry of Health, in competition with the Autonomous Communities, is finalizing a document on “the social and family context conditions that would be advisable to include in the digital health history.” in order to standardize the criteria, encourage registration and promote the biopsychosocial approach from the consultation.
