Social determinants of health (SDOH) are receiving more and more attention. Many areas believe that community health paramedicine is the quintessential way to assess a person’s social determinants of health and take the first steps to initiate definitive care.
How can community paramedicine drive change with SDOH? By learning about social determinants and integrating these assessment practices into their response, paramedics can help improve the overall quality of a patient’s life. Here are some of the social determinants that community paramedics can look for: housing, environment, nutrition, family structure, and compliance with treatments.
In the sections below, we’ll talk about several ways community health paramedicine can have a positive impact, such as uncovering SDOH and getting people real help.
What is SDOH, and How Can Community Paramedicine Make a Difference?
Social determinants of health (SDOH) refer to the innate qualities of a person’s life that can help “determine” risk factors for disease and injury. SDOH typically refers to external health concerns – meaning these health risks are not necessarily innate to the person’s genetics. Instead, they are based on the social environment. What are some examples of social determinants of health?
An example of a social health determinant is a person’s living environment. Living too far from healthcare might make them less likely to follow up on check-ups. If they live near an area of high pollution, they will be at greater risk of contracting chronic illness. Not having access to healthy food can harm a person’s long-term health.
In the following sections, we’ll talk about how community paramedicine is uniquely positioned to uncover some of these social determinants and how MIH-CP programs can help.
How Mobile Integrated Healthcare-Community Paramedicine Can Make Positive Change with SDOH
Now, let’s go over the practical ways that community paramedicine can impact the community with SDOH. Near the end of this article, we’ll discuss some practical ways community paramedic programs can work toward achieving larger goals.
Here are three main ways MIH-CP can drive change with SDOH:
- Environment assessment
- Housing assessment
- Compliance and medication
In the following three sections, we’ll outline these in more detail.
MIH-CP and SDOH Regarding the Environment
Part of the social determinant of health is the patient’s environment. While physicians and nurses do their best to question patients in the hospital or clinical environment, there is only so much they can do from a distance.
The community paramedic is on the ground, in the neighborhood, entering the patient’s home. This gives MIH-CP teams the best angle to assess a patient’s environment. With the environmental assessment, community paramedics might ask questions about the neighborhood’s safety, consider if there’s any local pollution (water supply, clear air, etc.), and determine where the patient is located in relation to healthcare.
Performing a broad-scale environmental assessment will give physicians the data they need to treat patients better. As an example, consider a patient who’s being treated for COPD. It could be that this patient lives right next to a factory that emits harmful vapors/odors/fumes that negatively impact the patient. Unless someone specifically investigates the problem, the patient might never get the necessary care.
Now, let’s talk about something related to the environment, specifically housing.
MIH-CP and Housing Assessment
Housing and the environment go hand in hand, but they are not the same thing. Environment asks, “Where are they living?” housing asks, “What are they living in?”
For example, a patient might be homeless and live in a bad environment. A patient might live in an upscale neighborhood yet still be at risk of environmental issues.
When community paramedics consider the SDOH and housing, they will assess the patient’s home specifically. For example, perhaps the patient has been treated for repeated falls/concussions. It could be that the patient is continuously tripping on their outdoor steps or falling in the bathroom. Perhaps the patient doesn’t have the money or resources to install ramps and handlebars.
All this might seem like small stuff, but it’s crucial. Something as simple as a ramp could be why patients repeatedly access the ER. Unless there is someone like a community paramedic to assess the patient’s home, these issues will go unnoticed.
Let’s talk about another way community paramedics can help recognize SDOH.
Compliance with Medications and Home Therapy
Community paramedics can also see whether social determinants are actively inhibiting care. Consider a patient who goes to their physician to receive diabetes treatment. Perhaps the physician prescribes a medication. At this point, it is up to the patient to retrieve the medication from the pharmacy. It is also up to the patient to take the medications regularly and the correct dose.
While these tasks might seem menial, they can present significant hurdles for many patients. For example, patients might rely on family members to fill their prescriptions. The patient might not receive their medication if that family member is unreliable.
Community paramedics are uniquely positioned to determine if patients have the resources to follow through with “the doctor’s orders.” Again, suppose the patient was not taking their medications or complying with their physician’s guidelines. In that case, it’s likely that no one would ever know, as there is no one in their home to assess the social determinants of the patient’s health. And it’s in these areas that community paramedicine programs can have a considerable impact.
All this may sound like a good idea, but how do you actually get there?
How to Prepare a Community Health Paramedicine Program for Greater SDOH Impact
Social determinants of health are a big part of the patient’s overall health picture. However, for community paramedic programs to make a real impact, they must build a strong foundation. With that said, let’s look at several ways community paramedics can improve their ability to serve the community and drive positive change.
How to improve MIH-CP programs to address SDOH better:
- Focus on increased training for community paramedics
- Create connections within the community
- Keep the conversations going in the community (extra push)
Below, we’ll unpack each of these steps in more depth.
Train Community Paramedics to Recognize SDOH
The first step is to give paramedics the tools and training to recognize more social determinants. Sometimes, this is as simple as incorporating a new survey or assessment tool into the community paramedic’s protocols. Other times, this means taking time to help community paramedics better understand the areas they serve and the unique needs of different communities.
As the old saying goes, “knowledge is power” – this couldn’t be truer regarding assessment skills. Just training community paramedics to be aware of specific social determinants will improve patients’ overall care.
How Community Paramedicine Programs Can Create More Connections
Part of the initiative with community paramedicine is getting away from the traditional methods of the 911 response, where (regardless of the patient’s broader health picture) the patient is driven to the ER and then largely forgotten.
When recognizing social determinants, community paramedics should aim to move beyond just assessment. Instead, they should build the support and the connections necessary to solve the problem.
For example, consider the patient who needs a ramp up to their front porch. Rather than just noting that the “patient has accessibility issues” in the report, community paramedics should have the connections and ability to make electronic referrals, make phone calls, and initiate definitive action. If they have a connection with local senior services, perhaps they can make the call and get a patient that ramp by the end of the week.
What’s the goal? Preventing problems from becoming lost in the vast ether of healthcare.
Keep Having the Conversations about SDOH and MIH-CP
Sometimes, you have to continue fighting for something to make any headway. The reality is that no matter how noble the aims of a community paramedic program are, other people often have their own list of problems on the agenda.
If community paramedicine wants to establish real change within their area, they must keep knocking on doors and having conversations (even when some people aren’t interested initially). One of the best ways to keep these conversations going is to participate in local town hall events, attend local community meetings, and have regular stakeholder meetings with your current partners.
Positive change rarely comes easy. However, patience and persistence are often the secrets to lasting impact.
Final Thoughts: How MIH-CP Programs Can Impact the Community Through SDOH
Community health paramedicine is in a great position to drive positive change with SDOH. Community paramedics are in patient’s homes, interacting with their environment, and witnessing their daily lives. Social determinants such as environment, housing, nutrition, family dynamics, and compliance with treatment can all be assessed and treated by MIH-CP.
If you’re curious to learn how to establish connections within the community and improve the impact of your community paramedic program on SDOH, contact Julota. A representative would happily answer your questions and discuss how Julota’s integrated platform can improve collaborations, documentation, and community satisfaction.