Six Strategies for Radiologists to Improve Health Equity

COVID-19 has shone a bright light on the impact of social determinants of health.

The concept of social determinants of health isn’t new, but the COVID-19 pandemic has shone a harsh light on their real impact as more cases and deaths have been experienced by minority patients, the uninsured, and those with a lower socioeconomic status – but radiology can take steps to improve this situation.

These issues are an outgrowth of long-standing inequities that also appear in radiology, such as reduced access to mammography or lung cancer screenings that can delay diagnoses, said a team led by Peter Abraham, M.D., a radiology resident at the University of California at San Diego.

“In radiology, social determinants of health lead to disparate use of imaging services through multiple intersecting contributors, on the provider and patient side, affected diagnosis and treatment,” they said. “Interventions designed to mitigate social determinants of health could help to equalize the healthcare system.”

For radiologists and radiology departments seeking to minimize the impacts of these social determinants, Abraham’s team recommended six strategies:

Train your staff: Offer training that can address biases and put stricter, race-neutral imaging guidelines in place. This can, potentially, bolster the lower imaging rates that minority patients currently experience due to possible provider bias.

Be flexible: Make appointments easier to get. Patients who have work or family responsibilities can benefit from walk-in or extended appointment times.

Make it affordable: Patients who are un- or underinsured will often forego imaging exams that can be critical to their health, they said. To make imaging more financially available, consider offering reduced-price or free screenings and abandoning policies that fine patients for missed appointments or lateness. It can also be helpful if you opt to accept a wide range of insurers.

Be more accessible: Consider building more imaging centers in lower income neighborhoods or arrange transportation for these patients to your facility. In addition, put technology solutions in place that can track incidental findings for these patients and expeditiously transmit them to a primary care provider.

Cultural competence: Be sure your staff is prepared to communicate with patients in a language other than English, the team said. Hire staff members who are bilingual or employ translators, and avoid asking questions about immigration status.

Improve understanding: Misunderstanding about the importance of screening exams can be a barrier. Be sure you’re offering decision support materials that offer clear guidance and that can improve patient-provider communication. Offer written materials in other languages, as well as ones with illustrations, that can help patients make their health decisions or better understand imaging procedures.

Making changes to improve health equity and reduce the impact of social determinants of health is critical, Abraham’s team said, particularly as the healthcare industry enters the post-COVID-19 environment. But, reaching this goal will take a great deal of work.

“Equity within radiology and healthcare, in general, cannot be achieved without cooperated, wide-scale efforts to address disparities in the social determinants of health,” they said. “Radiologists can help by addressing factors contributing to differential screening and intervention in order to provide all patients with the best possible care.”

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