Kidney Research Institute, Harborview Medical Center, Division of Nephrology, University of Washington, Seattle, WA.
Am J Kidney Dis. 2018 Oct;72(4):582-591. doi: 10.1053/j.ajkd.2017.12.016. Epub 2018 Mar 13.
There is ongoing recognition that a wide array of social, economic, and environmental factors influence individuals' opportunities to engage in health care and healthy behaviors. Despite spending $34 billion annually on the care of patients with end-stage renal disease, the American public and nephrology community remain remarkably complacent about addressing "upstream" factors that influence the prevention, progression, and treatment of chronic kidney diseases. Recently, a growing number of health plans and dialysis providers have begun to embrace population health management; accept greater accountability for health, health care, and health costs; and envision kidney health beyond their traditional roles in care delivery. This narrative offers a framework to evaluate social determinants of health and understand their link to chronic kidney diseases and provides recommendations for integrating social determinants into clinical care and delivery settings to assist vulnerable patients with broad social needs. Addressing unmet social needs with the same intention as treating hypertension, proteinuria, or anemia represents an important step toward making optimal health a palpable reality for all people who are at risk for or affected by chronic kidney diseases.
人们逐渐认识到，广泛的社会、经济和环境因素影响着个人获得医疗保健和健康行为的机会。尽管美国每年在治疗终末期肾病患者方面花费 340 亿美元，但美国公众和肾脏病学界在解决影响慢性肾脏病预防、进展和治疗的“上游”因素方面仍然非常自满。最近，越来越多的健康计划和透析提供商开始接受人口健康管理；对健康、医疗保健和医疗费用承担更大的责任；并期望超越传统的护理角色，关注肾脏健康。本报告提供了一个评估健康决定因素的框架，并理解它们与慢性肾脏病的关系，并为将社会决定因素纳入临床护理和交付环境以帮助有广泛社会需求的弱势患者提供建议。以与治疗高血压、蛋白尿或贫血相同的意图来满足未满足的社会需求，是使所有面临或受慢性肾脏病影响的人都能实现最佳健康的重要一步。
