How Engaged Are Family Physicians in Addressing the Social Determinants of Health? A Survey Supporting the American Academy of Family Physician's Health Equity Environmental Scan
How Engaged Are Family Physicians in Addressing the Social Determinants of Health? A Survey Supporting the American Academy of Family Physician's Health Equity Environmental Scan
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DOI：
10.1089/heq.2019.0022
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发表时间：
2019-01-01
期刊：
影响因子：
2.7
通讯作者：
Schoof, Bellinda
中科院分区：
文献类型：
--
作者：
Kovach, Kevin A.;Reid, Kathy;Schoof, Bellinda
公共卫生领导人倡导临床和基于人口的干预措施，以解决健康的社会决定因素（SDoH）。美国家庭医生学会一直致力于支持家庭医生解决SDoH问题。然而，家庭医生参与的程度和影响因素尚不清楚。方法：一项调查，以确定家庭医生采取行动，以解决SDoH和感知的障碍。医生和社区的特点相关联。有序逻辑回归被用来确定与从事临床和人口为基础的行动，分别相关的因素。结果：共收到434份（8.7%）回复。在受访者中，81.1%的人从事至少一项临床行动，43.3%的人从事至少一项基于人群的行动。时间（80.0%）和人员配备（64.5%）是最常见的障碍。医生的经验与较高水平的临床参与度相关，较低的家庭收入中位数与较高水平的基于人口的参与度相关，而在联邦合格的健康中心工作与两者都相关。结论：该研究提供了初步信息，表明家庭医生正在通过临床和基于人口的行动来解决SDoH。较新的家庭医生和那些在社区卫生服务中心工作的人可能是试点临床行动以解决SDoH的良好目标，家庭医生倡导者可能更有可能来自社区卫生服务中心或社会经济地位较低的社区。该研究还提出了关于为弱势社区提供服务的家庭医生对临床干预措施以解决SDoH的价值的问题。
Purpose: Public health leaders have advocated for clinical and population-based interventions to address the social determinants of health (SDoH). The American Academy of Family Physicians has worked to support family physicians with addressing the SDoH. However, the extent that family physicians are engaged and the factors that influence this are unknown. Methods: A survey was used to identify actions family physicians had taken to address the SDoH and perceived barriers. Physician and community characteristics were linked. Ordinal logistic regression was used to identify factors associated with engagement in clinical and population-based actions, separately. Results: There were 434 (8.7%) responses. Among respondents, 81.1% were engaged in at least one clinical action, and 43.3% were engaged in at least one population-based action. Time (80.0%) and staffing (64.5%) were the most common barriers. Physician experience was associated with higher levels of clinical engagement, lower median household income was associated with higher levels of population-based engagement, and working for a federally qualified health center (FQHC) was associated with both. Conclusions: The study provides preliminary information suggesting that family physicians are engaged in addressing the SDoH through clinical and population-based actions. Newer family physicians and those working in FQHCs may be good targets for piloting clinical actions to address SDoH and family physician advocates may be more likely to come from an FQHC or in a lower socioeconomic neighborhood. The study also raises questions about the value family physicians serving disadvantaged communities place on clinical interventions to address the SDoH.