This article is based on a recent Alliance Industry Summit (AIS) presentation.
Health disparities are linked to social determinants of health (SDOH), which impact adequate access to healthcare, including education level and access to healthy food, adequate housing, transportation and healthcare services.1 Evidence supports the significant effect of nonmedical factors on overall physical and mental health. An analysis of studies measuring adult deaths attributable to social factors found that in 2000, approximately 245,000 deaths were attributable to low education, 176,000 were due to racial segregation, 162,000 were due to low social support, 133,000 were due to individual-level poverty, and 119,000 were due to income inequality.2 According to the Centers for Disease Control and Prevention, a person’s zip code is more strongly associated with life expectancy than race or genetics.3
Finding ways to deliver high-quality healthcare to an increasingly diverse population is a major challenge for the U.S. healthcare system. Now more than ever, healthcare professionals (HCPs) recognize the urgent need to enact interventions to address healthcare inequalities among their patients. These interventions range from one-on-one interactions to advocating for national policies to fight inequities. Yet, it can be overwhelming for HCPs to address disparities, and they often need outside guidance.
Independent medical education (IME) can be leveraged as a tool to heighten awareness and address the needs of HCPs seeking to reduce the impact of SDOH on patient outcomes at the individual, practice and system levels. It is time to start shifting educational design to focus on the application of this growing body of knowledge and develop practical strategies to address inequities in the healthcare system. IME provides a platform to bring together experts representing different specialties and professions to share their successes and challenges with addressing SDOH and equipping learners with strategies that they can bring back to their practices. Educational activities should include adequate time and opportunities for faculty engagement with learners, as there are many considerations and perspectives on the issues. Addressing SDOH takes a village, making an interprofessional and multidisciplinary approach key, as each member of the healthcare team brings a unique skill set and perspective to the table.
Developing IME focused on addressing SDOH and health disparities should take note from both medical and non-medical association literature on addressing the subject. For example, the National Academies of Sciences, Engineering, and Medicine has developed an algorithm that can be utilized in IME when determining the focus or structuring of the educational program across therapeutic areas. The algorithm consists of 5As — complementary activities that facilitate the integration of social care into healthcare: Awareness, Adjustment, Assistance, Alignment and Advocacy. While all aspects have the end goal of improving patient care, adjustment and assistance focus on improving care delivery specifically to individual patients based on information obtained about their social needs. Alignment and advocacy relate to roles that the healthcare sector or system can play in influencing and investing in social care resources at the community level. All of these activities are informed by efforts that increase awareness of individual or community-level social needs within a provider or healthcare system’s geographic region or for its target population.4 The 5As can be applied to education intended for changes at the individual, practice and systems level.
Research suggests that interventions in the patient–practitioner interaction are foundational to address disparities. Considerations for education targeted at individual change would include activities to improve knowledge and competence in identifying and screening for SDOH at patient visits and identifying and eliminating implicit bias. Education focused on communication skills to increase linguistic and cultural competence is important to foster an environment of trust to enhance shared decision-making.
At the practice level, there are notable gaps in operationalizing screening and assessment tools and implementing telemedicine, strategies that are recommended to reduce disparities. Therefore, educational efforts designed to promote competence and performance with these measures are of high value to HCPs. Improving interprofessional and multidisciplinary collaboration is critical to addressing SDOH, as mentioned above. Activities designed to improve the function of the multidisciplinary team to expand access to medications, technologies and other social support needs are essential to this work. Education should also consider a focus on strategies for adopting diversity, equity and inclusion (DEI) efforts in the makeup of staff and providers.
This point was driven home through a highly memorable moment from a recent program developed through a collaborative effort by Clinical Care Options, Practicing Clinicians Exchange and the Academy for Physician Associates in Cardiology on addressing SDOH in atrial fibrillation care. The physician associate faculty member described how intentionally seeking out medical students from similar backgrounds to their patient population instantly improved patient attitudes and engagement with their medical care. This example demonstrates how efforts that do not require significant time or resources can have a huge impact. And finally, a growing area of interest in IME is the support for quality improvement initiatives which are invaluable to making change within practices but can also uncover additional educational opportunities and findings that can be scaled to other practices or therapeutic areas.
Closing the gap in disparities at high levels, such as a healthcare system or at the state and national levels, may be challenging to address through IME alone. However, the IME platform can provide resources for learners looking to take action. In addition, states are now requiring CME for HCPs on implicit bias, DEI and health inequities, providing opportunities to reach broad audiences who have specific educational needs based on their region or state and local policies.
There is no shortage in the demand for well-designed IME focusing on actionable strategies to address healthcare inequities. High-quality and targeted education designed to meet the needs of HCPs in their daily practice is one of the many ways that supporters and providers can make a profound impact on the care and outcomes of patients at greatest need.
The referenced program was supported by an IME grant from the Bristol-Myers Squibb/Pfizer Alliance.
- World Health Organization. Commission on Social Determinants of Health. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Available at https://www.who.int/social_determinants/final_report/csdh_finalreport_2008.pdf. Accessed July 1, 2022.
- Galea S, Tracy M, Hoggatt KJ, Dimaggio C, Karpati A . Estimated deaths attributable to social factors in the United States. Am J Public Health. 2011;101:1456-1465.
- Centers for Disease Control and Prevention. Vital Signs telebriefing on heart disease and stroke deaths. 3 September 2013. Available at: www.cdc.gov/media/releases/2013/t0903-vs-heart-disease.html . Accessed July 1, 2022.
- National Academies of Sciences, Engineering, and Medicine. Integrating social care into the delivery of health care. Moving upstream to improve the nation’s health. 2021. Washington, DC. National Academy of Sciences.
Erika Brechtelsbauer, PharmD, BCPS, currently serves as the director of scientific strategy in cardiometabolic medicine at Clinical Educational Alliance (CEA). Prior to her role at CEA, she completed pharmacy residency training and served as a clinical pharmacy specialist in internal medicine within academic medical centers where she collaborated with interprofessional medical teams to provide evidence-based patient care, precepted pharmacy students and residents, designed educational programs for pharmacy and interprofessional audiences and participated in quality improvement initiatives.