Two University of Alabama at Birmingham School of Nursing faculty, Associate Professor and Senior Director of the Center for Nursing Excellence at UAB Hospital and HRTSA Clinic Connie White-Williams, PhD, RN, NE-BC, FAHA, FAAN and Jane H. Brock-Florence Nightingale Endowed Professor and Associate Dean for Clinical and Global Partnerships Maria Shirey, PhD, MBA, RN, NEA-BC, ANEF, FACHE, FNAP, FAAN, are the lead and senior authors, respectively, on an American Heart Association statement paper designed to alert health care providers of the importance of social determinants of health for underserved patients with heart failure.
Other UAB authors include Vera Bittner, MD, MSPH, Professor in the Department of Medicine Division of Cardiovascular Disease and Raegan Durant, MD, MPH, Associate Professor in the Department of Medicine Division of Preventive Medicine. Bittner also serves as Collaborating Cardiologist in the HRTSA Clinic and Durant also is Medical Director for Cooper Green Mercy Health Services. In addition, members of the HRTSA Clinic staff authored the case study provided in the online supplemental data for the statement.
Heart failure affects more than 6.5 million Americans, and more than a half-million new cases are diagnosed each year. Because heart failure management is complex, its effects are often compounded in underserved patients by lack of access to care, and often these patients must also make difficult decisions about their own health, particularly when the costs of medications and health care appointments are at odds with basic food and housing needs.
“The untoward consequences of social determinants of health may place patients at increased risk for more frequent hospital admissions,” White-Williams said. “And, patients with heart failure who are food insecure, struggle with transportation, and have less access to medications, education and health services may have significantly poorer outcomes. This scientific statement helps provide an understanding of the impact of the social determinants of health and includes competencies and assessment tools clinicians can use with their patients.”
In the scientific statement, White-Williams, Shirey and their co-authors provided models and frameworks to guide health care providers in understanding the social determinants of health and how SDOH affect the delivery of care. Interventions to address SDOH in patients with heart failure were provided to assist health care providers in the clinical setting.
“Many factors, including innate personal traits and biological characteristics, and family and community influences can provide insights that have the potential to guide practice, education, research and policy development around heart failure care,” Shirey said. “However, we must broaden the focus to address health equity and access to health care and the significant impact these have on heart failure. Using the WHO and the Vulnerable Populations conceptual frameworks in the clinical setting will help clinicians to understand social determinants of health and to seek opportunities and resources to help patients with heart failure manage their care.”
The authors say the WHO Conceptual Framework describes the relationship between complexities of the structural social determinants of health (political climate, social class, gender, ethnicity, cultural values, education, occupation and income) and intermediary social determinants of health (living and/or working conditions, behavioral and/or biological factors, or the health system itself) and their impact on the equity of health and well-being.
The Vulnerable Populations Conceptual Model demonstrates the importance of personal and social factors, as well as the relationship between available resources and behaviors that increase the risk of poor health, emphasizing socioeconomic and environmental resources within a community that influence factors that affect health such as individual lifestyle, cultural behaviors, and value systems. Vulnerability is increasingly visible among the chronically ill and their caregivers. Self-care management demands further exacerbate patients’ and their families’ vulnerabilities as a result of not only job loss and increased health care costs but also declining social connectedness and status within a community.
“Understanding both of these models and how vulnerabilities are created and predispose individuals to a risk of poor outcomes will help health care providers focus their efforts developing a better understanding how to assess and treat patients, taking onto account social determinants of health care, and, in the long term, improving outcomes in underserved patients with heart failure,” White-Williams added.
They also advise when treating underserved patients with heart failure best practices call for an interprofessional provider team, such as social work, public health, pharmacy, nursing and medicine, working together with patients and families across the health care continuum to achieve the best outcomes.
“Interprofessional care teams can maximize patient access to varied perspectives and skill sets, which helps facilitate self-care and navigation across the health care system, which is most beneficial in improving the health outcomes of underserved patients with heart failure,” Shirey said.
Ultimately, the authors say that a social determinants of health assessment should be incorporated into the care of patients with heart failure. When social determinants are identified, the interprofessional team can intervene to assist patients to be better stewards of their health.
Other authors on the paper are Vice Chair Laura P. Rossi, PhD, RN, Assistant Professor Simmons School of Nursing and Health Sciences and Massachusetts General Hospital; Andrea Driscoll, PhD, NP, FAHA, Professor, Deakin University School of Nursing & Midwifery Austin Health, Department of Cardiology, Melbourne, Victoria, Australia; Bradi B. Granger, PhD, RN, FAHA, FAAN, Professor, Duke University School of Nursing and Director, Heart Center Nursing Research Program Duke University Health Systems; Lucinda J. Graven, PhD, MSN, FAHA, Assistant Professor, Florida State University College of Nursing; Lisa Kitko, PhD, RN, FAHA, FAAN, Associate Dean for Graduate Education and Associate Professor, Penn State College of Nursing; and Kim Newlin, ANP, CNS, FAHA, Cardiology Adult Nurse Practitioner, Cardiovascular Clinical Nurse Specialist, Clinical Manager of Cardiac and Pulmonary Rehab, Cardiovascular and Pulmonary Transitional Care Team, Sutter Roseville Medical Center, Sacramento.
White-Williams earned her MSN and PhD from the UAB School of Nursing in 1991 and 2009, respectively. Graven earned her PhD from the UAB School of Nursing in 2014.
