How can I assess the impact of social determinants of health on the outcomes of my patients with chronic diseases?

To assess the impact of social determinants of health (SDOH) on outcomes in patients with chronic diseases, start by systematically collecting data on key social factors such as socioeconomic status, housing stability, education, employment, social support, and access to healthcare services during patient assessments. This can be integrated into routine clinical reviews and chronic disease management plans to identify patients at higher risk of poor outcomes due to social vulnerabilities NICE NG16.

Use validated screening tools and questionnaires designed to capture social needs and barriers, such as those addressing financial hardship, food insecurity, or social isolation, which are known to influence disease progression and treatment adherence Guillemin et al. 2014Quiñones & Hammad 2020. Incorporate this information into electronic health records to enable longitudinal tracking and tailored interventions.

Engage multidisciplinary teams including social care, community health workers, and voluntary sector partners to interpret social data and co-develop personalised care plans that address identified social risks, thereby improving health equity and outcomes NICE NG44,NICE NG214.

Regularly review population-level data within your practice to identify patterns of social disadvantage linked to chronic disease outcomes, enabling targeted community engagement and resource allocation NICE NG44.

Finally, consider the broader context of integrated health and social care approaches, as recommended in UK guidelines, to holistically address the social determinants impacting chronic disease management and reduce inequities in health outcomes Guillemin et al. 2014Quiñones & Hammad 2020 NICE NG214.