Page 16 - Layout 1

SOCIAL DETERMINANTS SOCIAL DETERMINANTS
OF HEALTH OF HEALTH

Figure 1

Access to

Healthcare:

Threats & Opportunities

Requiring Physician Action

By Lyssa Ochoa, MD

Introduction geon to want to fix a problem right now led me to explore the one can limit access to care. A geographic review of National Provider Opportunities for the Practicing Physician
I’ll never forget the first time I was told by a PhD epidemiologist component I and my physician colleagues could impact at our own Identification numbers (see Figure 1), makes it clear where health- Thankfully, we physicians have a lot of latitude in addressing the
and San Antonio staple, Dr. Anil Mangla, that clinical care accounted discretion: access to care. care physical resources are located. We are at a deficit of over 150 issue of access to care. I’ve found the best way to focus my assessment
for only 20% of patient outcomes. In the year 2014, after 16 years of primary care providers south of downtown. There are two southside of the issue is to hone in on the common thread that intertwines pa-
education and training to become a vascular surgeon, and another 3 Threats Facing Access to Care hospitals compared to 30 downtown and north (reference) and, as tient access to care most frequently - transportation.
years in private practice in San Antonio, this claim felt outrageous. Even as I accepted that clinical care accounts for about 20% of out- of today, zero Medicare-accredited ambulatory surgery centers Like many, I first viewed transportation as the how patients get
However, my experience is San Antonio was being filled with examples comes, I remained convinced that it is a huge 20% (imagine having south of downtown compared to 40 downtown and on the north around: by car or bus, etc. Broadening transportation to include the
of extremely disparate outcomes, and I was looking for an explanation. access to 20% of Bill Gates’ fortune, for example)! Therefore, making side (reference). components of when patients can access care and where they will be
Covering a territory that stretched from Northeast San Antonio to sure patients had access to clinical care became an obvious place to There are many logistical concerns of all healthcare providers that accessing care allows us to design solutions that solve real access prob-
both corners of the southside, the differences were obvious. To use di- start. I needed to answer the question: Why don’t more patients have quickly become threats to access to care, even if they are common prac- lems in ways that are within our control.
abetic lower extremity amputations as an example (of course this out- easier access to care? tice. For example, standard 8am-5pm Monday-through-Friday busi- Regarding how patients get around, a common barrier we can in-
come was present in both the north and south areas of town) the Transportation was an obvious answer, with so many wrinkles ness hours mean that many patients cannot access care when they are tervene upon is insurance-assisted transportation. We can train our
magnitude of difference in disease state and age at presentation, I within itself. Some patients don’t have their own vehicle; others share done working. Also, because so many of our healthcare providers are schedulers to understand how insurance-assisted transportation
thought, must be correlated to education, literacy, and socioeconomic a vehicle within the family; still others, such as children and the elderly, already overworked and understaffed, the typical “next available ap- works, including limitations such as 72-hour notice, the patient iden-
factors that I had not been trained thoroughly to understand nor to may have no control over their own transportation. Some ride bikes, pointment” may be many weeks out. tifiers needed to schedule on a patient’s behalf and other logistics that
intervene upon. If I really wanted to make a difference, I needed more some ride the bus, some call friends to help, others Uber or rely on in- Then there is the black swan event we are experiencing right now: may help us help the patients. Chances are, if a patient’s circumstances
tools in my toolbox than scalpels, wires and catheters. surance-provided options which are frequently challenging to logisti- COVID-19. The COVID-19 pandemic’s impact on access to care will require them to rely upon insurance-assisted transportation, they
This began my dive into Social Determinants of Health. With top- cally navigate. There are dozens of situations our patients face other certainly be studied for years to come, and I am sure we would all agree probably also need assistance navigating the ins-and-outs of setting up
ics ranging from historical racist segregation policies to investment than what we assume to be the baseline of: “When I need to access it has been significant. Trying to find a silver lining, we ought to able such transportation. Another way to intervene upon how patients ac-
in neighborhood sidewalks and availability of fresh produce, I was care, I get into my car and drive to the care at my convenience.” to learn from, appreciate and respond to patient access to care that cess care is to familiarize our staffs with non-profit transportation re-
clearly in the deep end of an unfamiliar pool. My tendency as a sur- Additionally, the physical distribution of health care resources truly originates from completely external, large-scale forces of nature. sources in our area. RideConnect Texas and Jefferson Outreach are
continued on page 18

16 SAN ANTONIO MEDICINE • January 2021 Visit us at www.bcms.org 17