A Physician's Sense of Responsibility to Address Disparities: Does It Relate to Reported Behaviors About Screening for and Addressing Social Needs?

PURPOSE: It is widely accepted that negative social determinants of health (e.g., poverty) are underlying drivers of poor health and health disparities. There is overwhelming support among physicians to screen for patient-level social needs, but only a minority of clinicians actually do so. The authors explored potential associations between physician beliefs about health disparities and behaviors to screen and address social needs among patients. METHOD: The authors used 2016 data from the American Medical Association Physician Masterfile database to identify a purposeful sample of U.S. physicians (n = 1,002); data obtained in 2017 were analyzed. Chi-squared tests of proportions and binomial regression analyses were employed to investigate associations between the belief that it is a physician's responsibility to address health disparities and perceptions of physician behaviors to screen for and address social needs, accounting for physician, clinical practice, and patient characteristics. RESULTS: Of 188 respondents, respondents who felt that physicians have a responsibility to address health disparities were more likely than their peers (who did not feel that physicians have such a responsibility) to report that a physician on their health care team would screen for social needs that were psychosocial (e.g., safety, social support) (45.5% vs 29.6%, P = .03) and material (e.g., food, housing) (33.0% vs 13.6%, P < .0001). They were also more likely to report that a physician on their health care team would address both psychosocial needs (48.1% vs 30.9%, P = .02) and material needs (21.4% vs 9.9%, P = .04). With the exception of screening for psychosocial needs, these associations persisted in adjusted models. CONCLUSIONS: Engaging physicians to screen for and address social needs should couple efforts to expand infrastructure with educational efforts about professionalism and health disparities, especially underlying drivers such as structural racism and the social determinants of health.

A Narrative Review of Physician Perspectives Regarding the Social and Environmental Determinants of Obesity.

PURPOSE OF REVIEW: Diet-related chronic diseases result from individual and non-individual (social, environmental, and macro-level) factors. Recent health policy trends, such as population health management, encourage assessment of the individual and non-individual factors that cause these diseases. In this review, we evaluate the physician's perspective on the individual and non-individual causes and management of obesity. RECENT FINDINGS: Physicians generally rated individual-level causes (i.e., biology, psychology, and behavior) as more important than social or environmental factors in the development of obesity, and utilized individual-level strategies over social or environmental strategies to manage obesity. This review suggests that clinicians perceive individual characteristics to be more important in the development and management of obesity than social or environmental factors. Additional research is needed to understand why.

Development of a Multifaceted Health Disparities Curriculum for Medical Residents.

BACKGROUND AND OBJECTIVES: Health disparities education is required during residency training. However, residency program directors cite numerous barriers to implementing disparities curricula, and few publications describing successful disparities curricula exist in the literature. In this report, we describe the development, implementation, and early evaluation of a longitudinal health disparities curriculum for resident physicians. We provide resource references, process, and didactic toolkits to facilitate use by other residency programs. METHODS: We used a standard, six-step model for curricular design, implementation, and evaluation. We assessed feasibility of curricular development including practicality (program cost and time requirements) and demand (resident engagement). We also assessed program and learner outcomes, including number of didactic and clinic sessions delivered and resident preparedness, attitudes, and skill in caring for vulnerable patients. RESULTS: We designed, implemented, and evaluated our curriculum in less than 1 year, with no external funding. Time costs included 100 chief resident and 20 faculty hours for curricular development, followed by 20 chief resident and 16 faculty hours for implementation. In the first year of our curriculum, 21% of residents (16 of 75) participated. We created eight didactic sessions and delivered four as intended. Residents provided 84 free clinic sessions for uninsured patients and reported increased preparedness and skill caring for vulnerable patients in 15 of 20 measured domains. Residents also reported 20 commitments to change on themes that comprehensively reflected the content of our first curricular year. CONCLUSIONS: It is possible to design a disparities curriculum, overcome cited barriers, and improve educational outcomes related to the care of vulnerable patients.