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How to address social determinants of health — start with texting


Physicians today need to think smart when it comes to connecting with the communities they serve.

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One of the most daunting challenges facing healthcare organizations today is how to improve care results and patient outcomes for those negatively impacted by social determinants of health (SDOH). Defined simply, these are the conditions in the places where people live, work, and play that affect a wide range of health risks and outcomes. 

Social determinants of health often touch the underserved and at risk populations in our communities. For example, one in 10 people in the U.S. doesn’t have health insurance due to poverty or other socio-economic factors. Without health insurance, people may not be able to afford health care services and needed medications.

Social determinants are also associated with patient nonadherence, which adds another wrinkle to the already complex problem. A case study of a Michigan healthcare system found patients’ lack of a primary care provider and not taking medications as prescribed are the two biggest reasons for health system readmissions. The question then becomes what strategies can providers leverage to address social determinants and nonadherence that will lead to improved patient engagement and outcomes?

One current approach is for providers to reassess how they connect with patients that fall within these demographics and consider tapping the technology that most people use every day. Text messaging has been found to be one of the most effective and efficient ways to extend a provider’s reach to patients and get results. Since most people have smartphones, texting is a fast and convenient way to communicate with individuals or groups.

In one study, researchers wanted to determine how to help elderly patients with chronic disease increase their prescription medication refill rates. By sending text message reminders to the patients that employed conversational AI, prescription refills increased by nearly 20 percent. The text reminders proved a highly effective method for providers to communicate with patients and get them the prescription refills they needed, which resulted in better adherence and care outcomes.

In other studies, there was strong evidence that text-message based health interventions such as reminders, patient education, or self-management improved health outcomes of participants. They included better outcomes in healthy behaviors, improved chronic disease management, increased vaccinations of adolescents, and reduced alcohol and drug use.

A digital patient communication system powers automated texts for appointment reminders to help reduce no-show rates, patient recall messages to get underserved populations the care they need, and group messaging to easily communicate targeted preventative care education to specific patient demographics. In place of time-consuming phone calls, staff are able to connect with patients in a way that’s less intrusive and is more likely to drive desired results.

In the Michigan case study, the healthcare provider sought a way to address patients’ needs in the midst of the COVID-19 pandemic where face-to-face contact wasn’t always possible. A virtual urgent care program was established, similar to a nurse health line so patients could contact staff to set them up with a provider, order a COVID-19 test, or get them medications. A two-way texting feature was added to the virtual urgent care line that so that patients could contact the provider with specific care questions and get answers quickly without ever making a call. 

Since many of the Michigan system’s patients are affected by social determinants, such as lack of social support and isolation, those factors impact their ability to avoid poor outcomes and readmissions. The virtual urgent care line’s texting capability gives the provider another touchpoint with which to reach out to patients with follow-up messages that check how they’re doing and let them know staff are there to help. In this way, the provider can extend its range to a larger patient pool without overburdening staff resources with time-consuming communications. The organization’s leaders say texting is having a significant impact on engaging patients early to improve the health of their community.

Healthcare organizations today need to think smart when it comes to connecting with the communities they serve. They must find innovative means to amplify communications and connect efficiently yet meaningfully on an individual basis that will help lead to greater patient engagement among underserved and at-risk populations. Clearly, text messaging is a 21st century tool that can help providers change behaviors, reduce readmissions, and get patients the care they need.

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Josh Weiner is the CEO of SR Health by Solutionreach. He joined Solutionreach from Summit Partners, a leading global growth equity firm. Through his work with Summit Partners, Josh served on the Solutionreach board of directors for three years. Prior to Summit Partners, he was a consultant with McKinsey & Company. Weiner has been recognized by Utah Business as a 2017 CXO of the Year and as a 2018 Forty Under 40 Utah Rising Star. Josh is a graduate of Stanford University and resides in Salt Lake City with his wife and two children. Josh and his family spend as much time as possible exploring the natural wonders of Utah's mountains and desert. Connect with him on LinkedIn @joshfweiner

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© National Institute for Occupational Safety and Health
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