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On upstreamists, and pharmacists, in the continuing conversation on #SDOH

May 12th, 2018

I’m still not done talking about the Social Determinants of Health (#SDOH). On the contrary, I’m fired up even further after the April 18 gathering at Oakland University for the conference MedNetOne Health Solutions co-presented with the Oakland University School of Health Sciences: Better Upstream Health for Better Downstream Care.

Approximately 170 kindred spirits and current and future upstreamists gathered for a full day of discussing how Michiganders can take aim at some of the key drivers of poor health by  supporting (and funding) activities that mitigate negative social realities earlier in the game. An example I like to use is an individual with Type 2 diabetes whose social determinants are few economic resources, inability to purchase testing supplies and insulin, limited access to affordable, healthy food and fractured or non-existent personal support systems. Upstreamists would be called in (and reimbursed) for efforts that work to prevent the sometimes deadly and often costly disease. More intervention is needed before a crisis hits –although I’d argue the crisis is already here.

Speaking of diabetes, this offers me another opportunity to turn the conversation to one of my favorite professions on the health care continuum – pharmacists. If you’ve read this blog with any regularity, you know I believe that pharmacists play a pivotal, and too often undervalued, role in patient care. I had the privilege of recently providing #SDOH training to 25 pharmacists who came from as far away as Muskegon to be part of the solution. They and their pharmacy colleagues are our boots on the ground, the upstreamists who invented the term without knowing it just by virtue of their role as a trusted, in-person or telephonic source for healthcare questions. They see individuals who receive their medications (many of which are for diabetes, asthma, hypertension) in traditional settings (rather than via the mail) and can often gauge general health and wellness through one on one conversation. We need them – and you – in our #SDOH community of professionals. They should be recognized as providers, but that’s a topic for another blog.

Someone asked me a few days after the #SDOH conference what my biggest take-aways were. Besides being invited to travel to Ireland and meet with healthcare leaders there by conference presenter Paul Grundy MD, MPH, (I had to decline the invitation), I want to revisit an idea presented by our conference keynote, Rishi Manchanda, MD, MPH. Rishi is a public health innovator who has worked in South Central Los Angeles and advocates for incorporating #SDOH into primary care. He shared his Upstream Strategy 3×3™, which is a quick matrix of solution strategies for #SDOH issues. The first (3) is the three levels of prevention: primary prevention, secondary prevention and tertiary prevention. The second (3) in the 3×3 is 1. Mapping clinical and community needs and resources. 2. Identifying interventions to improve care and health-related social needs for priority populations (example: diabetes and food insecurity) and 3. Choosing clinical-community partnerships to implement early win interventions. A matrix is not a solution but, in this case, it is a roadmap for where and when various upstreamist individuals and organizations can enter into the upstreamist intervention role. Let me know if you’d like a copy of the slide.

The engagement of the #SDOH conference is continuing through monthly conference calls among conference participants to exchange information and ideas. It’s spearheaded by MedNetOne; I’m telling you this not only because I want you to have access to upstreamists and their ideas –but because I want you to be part of the solution as well. And, in all honestly, because I want to be held accountable for keeping the momentum going to tackle #SDOH issues in Michigan. Your help – and watchful eye – would be much appreciated.  If you want to be part of Michigan’s fledgling upstreamist community network, contact me at ematuszewski@mednetone.net

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