Cardiovascular disease, or heart health will always be an important topic. For this month’s article, I’m going to review recommendations that came out of the American College of Cardiology meeting this past March. The ACC, together with the American Heart Association put together guidelines for the primary prevention of cardiovascular disease.
We’ve discussed many times in these articles that primary prevention means to prevent a disease from occurring. Secondary prevention is trying to prevent a complication or worsening of a condition someone has been diagnosed as having.
Most of the top ten recommendations have been discussed here over the last few years. Things like living a healthy lifestyle; eating a healthy diet; being more physically active; managing your diabetes well; stop smoking or never start to smoke; managing blood pressure to the new guideline of less than 130/80; and using statins (cholesterol medications) and aspirin only when appropriate.
One item that I haven’t discussed much is evaluating a patient’s social determinants of health. This topic covers the aspects of a patient’s life that affects their health and how they interact with the healthcare system.
One screening tool asks questions in several broad categories: housing, food, transportation, utilities, safety, and if patient needs help in any of these areas. Let’s look at some of these categories and how they impact health.
For housing the basic question is about having someplace to live. We care for people who don’t have reliable housing. This impacts their care by making it difficult to maintain a routine schedule for medications. Sometimes, it is difficult to keep medications safe when moving from place to place.
When someone doesn’t have access to appropriate food, it is not reasonable to expect them to always make the best choices. Sometimes beans and rice are the best a patient can do and watching for appropriate numbers of carbs and protein just isn’t a priority.
Some of our patients don’t drive or have reliable transportation. It is unreasonable to expect a patient who doesn’t like driving on freeways to go to a doctor all of the way across town. At Holy Cross, we usually recommend doctors in the downtown or medical center areas. For most of our patients, they can get to either area without using a freeway.
Utilities are another area we, as providers, don’t always think about. If someone is needing to make a decision about paying CPS or buying a medication, most will choose CPS. Safety involves not just physical safety, but emotional safety as well. Worry about the safety of where you live can be stressful and make managing things like blood pressure difficult. Emotional safety is also important. If someone is being abused physically or emotionally, they are not going to be able to make the best decisions for their health.
At our HealthTexas at Holy Cross clinic, we work to consider all of these areas when caring for patients. Our social worker and patient advocates can help with directing patients to community resources for help. My nursing staff does a great job helping patients manage their medications through reminders and encouragement.
In my almost 22 years of experience, it is not typical for a patient to choose to be non-compliant, especially when it comes to cardiovascular disease . Most patients try to do the best for their health. It is my job to work with them to address the issues they may not always be comfortable sharing about. My job, as a physician, is not to judge, but work through or around the issue to reach the goal of better health.
Please, if any of these areas are impacting how you care for yourself or your family, please talk to your doctor about them. Michael Dominguez, MD, FAAFP is board certified in Family Medicine. His office is located at HealthTexas Medical Group, 590 N. General McMullen, 78228, phone: 210-249-0212