Primary Care Physicians Link Social Barriers to Poor Health

Primary care physicians say pervasive and stubborn social barriers such as a lack of access to adequate housing, transportation, and nutritious, affordable food may impact patient health as much as access to direct medical care, a survey shows.   

The online survey of 1,000 primary care physicians, including 310 pediatricians, was conducted in September and October on behalf of the Robert Wood Johnson Foundation.

"What really becomes clear is that when you think about providing care, we have to think about more than just the medical service delivery system," Jane Lowe, team director for the Vulnerable Populations Portfolio at RWJF tells HealthLeaders Media.

"We have to think about how do we help physicians connect their patients to other providers or to services that are going to have as much impact on their health outcomes as the physician visit will have?"

They survey found that:

• 85% of physicians say unmet social needs are directly leading to worse health for all Americans.
• 85% of physicians say patients' social needs are as important to address as their medical conditions. This is especially true for physicians (or 95%) serving patients in low-income, urban communities. 
• 76% of physicians want the healthcare system to cover the costs associated with connecting patients to services that meet their social needs if a physician deems it important for overall health.
• Only 20% of physicians feel confident or very confident in their ability to address their patients' unmet social needs.
• Physicians said that if they had the power to write prescriptions to address social needs, these would represent 1 out of every 7 prescriptions they write— or an average of 26 additional prescriptions per week.

Lowe says the survey reflects a tremendous frustration on the part of primary care physicians who every day see barriers to good health that their patients face in the world beyond the office visit.

One common example of a stubborn environmental barrier that is cited by physicians is childhood asthma triggered by mold in substandard housing.

"If you are a physician, particularly a pediatrician, and you know the asthma could be easily managed if the environmental factors were changed, that has to be enormously frustrating," she said.

Lowe says the long-term costs of frequent asthma attacks have to be measured along with the short-term costs of frequent trips to a pediatrician or the emergency department.

"Asthma one of the biggest single causes of school absenteeism and it causes children to fall further and further behind in their studies," she said. "It has tremendous implications for their growth and development not just physically but socially, emotionally, and educationally."

Lowe says primary care physicians simply don't have the time to chase down and correct the socio-economic conditions that lead to adverse health effects for their patients. With that in mind, Lowe says she hopes the survey will bolster support for a RWJF-funded program called Health Leads that is now underway in about a half-dozen cities across the nation.

Health Leads relies on trained volunteer college students working with healthcare providers to identify social issues such as substandard housing or poor nutrition that may adversely impact patients' health. In addition, some hospitals team up with legal aid attorneys and other interdisciplinary teams that include social workers who take on substandard housing issues and other barriers.

"We are not naïve to think that physicians are going to do this," she says. "The most hopeful thing about this survey is that physicians are recognizing that there are these unmet social needs that are important to address, even though they don't know what to do about it."