Poverty--defined by the Centers for Disease Control and Prevention as a condition in which "a person or group of people lack human needs because they cannot afford them"--can pose myriad of challenges to a person's health. And with nearly 40 percent of the U.S. population meeting criteria to be considered "low-income," physicians must take special care to support such patients in a way that improves health outcomes, according to a new position paper from the American Academy of Family Physicians.
"Caring for a patient of limited material means requires sensitivity to and understanding of the patient's specific challenging circumstances in order to design a treatment plan that is achievable and sustainable," wrote authors Patricia Czapp, M.D., and Kevin Kovach. "Such an approach requires a culturally proficient medical home and a well resourced medical neighborhood that supplies readily accessible solutions."
The paper offered the following practical recommendations for physicians to incorporate such solutions into their practice workflows:
- Leverage coordinated, team-based care to help patients catch disease earlier in order to avoid costly complications and hospital-based care.
- Avoid judging patients who miss appointments or follow instructions incorrectly as "noncompliant" and have team members investigate and help address root problems such as lack of transportation, inflexible employers, poor literacy or other issues prevalent among low-income populations.
- Ask simple questions, such as, "Do you (ever) have difficulty making ends meet at the end of the month?" to start the conversation about socioeconomic obstacles to care.
- Create a prioritized, realistic, contextualized plan of care, recognizing that the "best" medication for a low-income patient is the one that the patient can afford and self-administer reliably.
- Help orient the newly insured. "For the novice, this can be a humiliating and bewildering process to navigate, and it is so important that we and our staff react with compassion and understanding to help the newly insured learn what it means to be a patient within a medical home," Czapp told AAFP News. "If we don't do this, they will revert to their previous pattern of behavior of using the emergency department, because that's the (only but inappropriate) medical home they know."