Clinical and medical staff approach patient engagements with particular health objectives in mind. First, they seek to help the patient. Second, they may also focus on performance metrics and targets like HEDIS, disease state clinical guidelines, or value-based care contract goals. For their part, patients seeking care approach the engagement in search of fulfillment of their medical needs. They may also have their own top-of-mind concerns and health outcomes goals.
These 2 perspectives can create misalignment, potentially leading to a lack of mutual understanding, unsupportive decision making, care plan failure, and erosion of the patient-clinician relationship.
Finding common ground
A patient may think, "Why does the doctor or nurse want me to take that medication or start doing things differently? Their clinician may think, "Why doesn't the patient get on board with my treatment plan?"
With so many health equity and social determinants of health programs focusing on creating person-centric care, clinician-patient interactions are a focus for improvement. Healthcare professionals are looking for strategies to deliver care centered on the patient while achieving the myriad outcomes and performance objectives.
Biomedical models don't account for social risk factors
Medicine has traditionally been a disease-focused, unidirectional paradigm. It presents a biomedical viewpoint that illness and disease are a function of physical processes encompassing pathology, biochemistry, and physiology. Traditional medicine doesn't, however, account for the role of social factors like income, transportation, housing, or food insecurities.
Figure 1 highlights the role that providers have in a biomedical model. The clinician assesses the patient and provides a diagnosis and treatment plan. The patient takes the treatment plan and is expected to implement it as given, often with little shared decision making and patient input into the treatment plan.
Figure 1: Shifting from solving a problem to supporting an individual.
Unfortunately, this top-down approach can fail to achieve the modern aims of high-quality, cost-efficient, and outcomes-oriented healthcare.
Patients encounter different experiences and outcomes
A scientific statement based on the American Heart Association's research highlights the vast differences that 2 patients can have with cardiovascular disease (CVD).
Table 1 describes the clinician's observations of Patients 1 and 2 from the report.
| Patient 1 | Patient 2 |
| He has been adherent to his prescribed med regimen. | He misses the scheduled 2 week cardiology appointment due to his work schedule. |
| He is curious about his blood pressure reading which is above goal. | With outreach from the cardiologist's office he does present for an appointment 2 weeks later. |
| He has gone on-line and has questions about an article he read about obesity and heart disease. He is interested in an exercise regimen and wonders when it will be ok to exercise again. | He expresses concern about taking so many medications. On review, he has been taking his blood pressure medication and aspirin only when he has a headache. TV commercials regarding statins' side effects dissuaded his use. |
| He admits he is worried that this could happen again. Of note, he hasn't smoked a cigarette since his hospitalization. | Everyone around him smokes so he has found it hard to cut down. |
Patient 1
Proactive approach from the biomedical model: Patient 1 demonstrates a proactive approach to understanding the nature of his disease, predisposing factors, medication treatment, and risk modification strategies. Such an orientation is congruent with the biomedical model, which asserts that patients can take control of their disease through adherence to therapy and lifestyle change.
More personal control and perspective: This reflects an underlying sense of personal control over his fate and a perspective oriented toward the future. This patient's respect for the biomedical model is congruent with most physicians' views and in accordance with physician expectations. Greater trust in the clinician: This patient's obvious respect for what his doctors have told him, his perception that he can be the master of his own fate, and his orientation toward having a healthy future reflect an endorsement of the biomedical view. Physicians may experience such an individual as a model patient.
This is contrasted with the perspective of a vast number of patients represented by the other patient.
Patient 2
Given the patient's doubt around information, SDoH intervenes with a plan: "Patient 2 demonstrates some doubt about the information and therapeutic plan he has been given, and various aspects of his life interfere with his adherence to the plan. Lack of trust and personal beliefs: The advice given during the hospitalization regarding aftercare and the need for medication therapy seems to have been eroded by perceived side effects and information from TV commercials, as well as his beliefs about his conditions and what might help treat them."
Understanding Patient 2's perspective
The clinicians' analysis found that Patient 2's views are not uncommon. Research has shown that “value systems or explanatory models that are incongruent with the biomedical model might contribute to lower adherence rates."
Patients often hold different views about their conditions and effective treatments than the biomedical model. These beliefs and a patient's ability to understand and have the resources to implement their care plan effectively can indicate some barriers to overcome to find common ground and alignment between provider and patient. Plus, patients likely have one or more social risks. In that case, helping address patient-identified social needs could help Patient 2 achieve the results of Patient 1.
Data bridges understanding and motivation gaps
Data from various sources can help bridge these gaps between the provider's and patient's understanding.
When physicians can access a patient's local area risk score, they can be informed about the types of health-related social needs the individual may face. Then social risk and needs assessments can reveal specific issues. These sources can help guide a clinician's open-ended questioning to hone in on a patient's beliefs, choices, and actions. This can help avoid unintended bias that a clinician could introduce, as well as deepen conversations that lead to successful, mutual decisions and care plan commitments.
A number of validated social risk and social needs assessments are becoming a part of standards of care, particularly those associated with value-based care models like care management, behavioral health integration, and other SDoH-driven interventions.
Creating person-centric, goal-directed care
Ultimately, the goal is to use social risk data to inform the care conversation and help the provider and patient understand each other better. Once they are both on the same page, they can form a partnership focusing on goal-directed, person-centric health improvement.
Figure 2: Shifting from a top-down to a bottom-up, person-centric approach to medicine.
As shown in Figure 2, the traditional biomedical approach—where a provider directs change from the top down—is complemented with change that the patient equally drives. A truly collaborative patient-to-provider relationship comes from knowing what is most important to the patient, identifying and mitigating barriers to care, and supporting patient-identified goals. It also meets the clinical, organizational, and contractual performance measures that providers are held to account.
Today, providers are increasingly seeing a more diverse population of patients with a broad range of perspectives regarding health, influenced by social and cultural backgrounds as well as their past experiences with healthcare.
Provider-patient relationships have been shown to influence patient satisfaction, adherence to medical care plans, and health outcomes. Leveraging these data sources can inform goal-driven, patient-provider communication that achieves both the patient's and provider's care objectives.
Providers looking to improve patient satisfaction and overall patient outcomes can benefit from localized data sources and experienced consultants with deep knowledge of SDoH and biomedical approaches. RTI can help your providers close gaps and improve the care experience. Contact us for more information.