Cumulative Adverse Financial Circumstances: Associations with Patient Health Status and Behaviors (Report) - Health and Social Work

Cumulative Adverse Financial Circumstances: Associations with Patient Health Status and Behaviors (Report)

By Health and Social Work

  • Release Date: 2011-05-01
  • Genre: Health & Fitness
Cumulative Adverse Financial Circumstances: Associations with Patient Health Status and Behaviors (Report) book review score

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Cumulative Adverse Financial Circumstances: Associations with Patient Health Status and Behaviors (Report) Health and Social Work Book Review Score: ★★★★★ 5/5 stars

There are approximately 39.4 visits per 100 people to U.S. hospital emergency departments (EDs) annually (Niska, Bhuiya, & Xu, 2010). Across health service disciplines, there is a sizeable, long-standing body of evidence establishing the role of the ED as a health system safety net for vulnerable populations, emphasizing the need for social work response to patients' psychosocial and economic needs in this medical setting (Bergman, 1976; Gordon, 1999, 2009; Gordon, Chudnofsky, & Hayward, 2001; Healy, 1981; Walls, Rhodes, & Kennedy, 2002). In general, the current responsibilities of social workers in U.S. EDs include addressing physician-identified social service needs, counseling and crisis intervention, discharge planning, and referral to relevant services (Auerbach & Mason, 2010; Holliman, Dziegielewski, & Datta, 2001). Typically, these direct, individualized interactions are brief, single-session contacts (Kitchen & Brook, 2005). Although the need for patient-level social work functions in EDs is well-researched, the value of system-level social health screening and response in EDs has yet to be established (Auerbach & Mason, 2010; Gibbons & Plath, 2005; Gordon, 2001; Keehn, Roglitz, & Bowden, 1994; McCoy, Kipp, & Ahern, 1992; Ponto & Berg, 1992). The result is that routine screening and referral for patient economic deprivation (for example, food insecurity, housing instability, unemployment or income security, lack of adequate health coverage for medications and physician care) are scarce practices in contemporary medical settings (Fleegler, Lieu, Wise, & Muret-Wagstaff, 2007). The relationship between socioeconomic well-being and biomedical and behavioral health is well-documented (Adler et al., 1994; Bosma, Schrijvers, & Mackenbach, 1999; Head & Faul, 2008; Krieger, Williams, & Moss, 1997; Lynch, Kaplan, Cohen, Tuomilehto, & Salonen, 1996; Oakes & Rossi, 2003; Schrijvers, Stronks, van de Mheen, & Mackenbach, 1999). In the United States, a patient's socioeconomic status (SES) is a multilayered construct that includes individual-, household-, and neighborhood-level consideration of social class, race and ethnicity, gender, education level, and income and access to financial resources (Krieger et al., 1997). Although no single SES factor explains the connection between SES and health, one component that is malleable is an individual's experience of financial constraints (Fleegler et al., 2007). Similarly, among the many other non-SES factors associated with disease and disability that lie outside the reach of public policy, individual financial constraints can be immediately addressed through broad health policies, physician treatment strategies (that is, prescriptions for less costly medications), and targeted social work referrals to existing public programs (Kaplan & Lynch, 2001; Piette, Heisler, & Wagner, 2004; Poleshuck & Green, 2008; Schrijvers et al., 1999).

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