A colleague of mine, Cheryl, has been trying to help a solo physician address a thorny issue. Through the use of How's Your Health, an amazing Web-based suite of health and practice tools, the physician realized that many of her patients struggled with maintaining an adequate income. Cheryl went looking for some ideas for the physician, and she came across this: Health Providers Against Poverty, an Ontario-based group that has a toolkit to help primary care' professionals address poverty issues.
Poverty is a simple, yet complex issue that is a major determinant of health. Not taking action to address it is like ignoring any other symptom or risk factor. Like so many things in primary care, it seems overwhelming. What's a provider to do?
First: Screen for income issues. I liked this simple screening question from the unpublished work of Vanessa Brcic and Caroline Eberdt: "Do you ever have difficulty making ends meet at the end of the month?" (It's 98 percent sensitive and 64 percent specific for those of you working on the basis of Spin and Snout.)
Second: Know what you can do about it. Dr. Gary Bloch, in a presentation created for the Family Medicine Forum this month in Vancouver, British Columbia, recommends adjusting risk based on what you know about income level as the first step in making a difference. After that, it's time to intervene directly and through others. Here are Dr. Bloch's ideas (which will need a bit of translating for American readers, but the principles are the same):
- Complete disability applications, welfare supplement and tax credit forms.
- Advise patients to complete their income tax, as most benefits are calculated from that.
- Inquire about other income supplementation for which they might be eligible.
- Know where to refer patients to obtain assistance.
Since Cheryl and the doctor she is working with aren't in Ottawa, Cheryl has been working to create specific tools for the Vancouver area.
What can you do to reduce poverty for the people you serve?