Addressing Social Determinants of Health in the Care of Patients With Heart Failure: A Scientific Statement From the American Heart Association
Addressing Social Determinants of Health in the Care of Patients With Heart Failure: A Scientific Statement From the American Heart Association
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DOI：
10.1161/cir.0000000000000767
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发表时间：
2020-06-02
期刊：
影响因子：
37.8
通讯作者：
Shirey, Maria
中科院分区：
文献类型：
--
作者：
White-Williams, Connie;Rossi, Laura P.;Shirey, Maria
心力衰竭是一种临床综合征，影响超过650万美国人，估计每年诊断出55万新病例。心力衰竭管理的复杂性因经历健康社会决定因素（SDOH）的不良下游影响的患者数量而变得更加复杂。这些患者获得护理的能力较低，并且随着时间的推移，更有可能经历不良的心力衰竭结局。许多患者面临着与复杂的慢性疾病管理成本相关的额外挑战，并且必须对自己的健康做出艰难的决定，特别是当药物和医疗保健预约的成本与基本食品和住房需求不一致时。本科学声明总结了SDOH和了解其对心力衰竭患者影响的重要知识现状。具体而言，本文件包括SDOH的定义，供应商的能力，和SDOH评估工具，并解决了以下问题：（1）什么模型或框架指导医疗服务提供商解决SDOH？(2)影响护理提供的SDOH是什么，以及针对这些影响心力衰竭患者护理和结局的干预措施是什么？(3)医疗保健提供者有哪些机会来解决影响心力衰竭患者护理的SDOH？我们还包括一个案例研究（数据补充），强调跨专业团队的努力，以解决和减轻的影响，SDOH在一个服务不足的心力衰竭患者。
Heart failure is a clinical syndrome that affects >6.5 million Americans, with an estimated 550 000 new cases diagnosed each year. The complexity of heart failure management is compounded by the number of patients who experience adverse downstream effects of the social determinants of health (SDOH). These patients are less able to access care and more likely to experience poor heart failure outcomes over time. Many patients face additional challenges associated with the cost of complex, chronic illness management and must make difficult decisions about their own health, particularly when the costs of medications and healthcare appointments are at odds with basic food and housing needs. This scientific statement summarizes the SDOH and the current state of knowledge important to understanding their impact on patients with heart failure. Specifically, this document includes a definition of SDOH, provider competencies, and SDOH assessment tools and addresses the following questions: (1) What models or frameworks guide healthcare providers to address SDOH? (2) What are the SDOH affecting the delivery of care and the interventions addressing them that affect the care and outcomes of patients with heart failure? (3) What are the opportunities for healthcare providers to address the SDOH affecting the care of patients with heart failure? We also include a case study (Data Supplement) that highlights an interprofessional team effort to address and mitigate the effects of SDOH in an underserved patient with heart failure.