Creating a Culture of Holistic Care in Lupus

Lupus is a chronic disease that can cause organ damage and hospitalization, resulting in high costs. GSK aims to improve care by considering social determinants of health.

Defining Social Determinants of Health

Health is affected by so much more than just visiting the clinic, getting prescriptions, and taking medicine. There are key social factors that affect life on a daily basis, depending on where people are born, grow, work, live and age, called “social determinants of health” or “social drivers of health.”2 Over his 2 plus decades of a professional career, Vijay has made social determinants a key part of population health research to inform health and health policy.

It is estimated that medical care only accounts for 10%-20% of the modifiable contributors to outcomes.  Other influences contribute to the rest. These include accessibility to proper care, transportation, insurance and education and others.2–4 All these factors can contribute to later diagnosis or delayed treatment,5–8 which can lead to worse outcomes for people living with lupus.5,9 Moreover, many of these social determinants of health are most prevalent in Hispanic/Latino and Black/African American communities,5,10–12 resulting in worse outcomes in terms of standard of care treatment adherence organ damage and hospitalization for these populations.5,13 This is why GSK is proudly partnering with clinical institutions to drive understanding and solutions for social determinants of health.

Vijay Nadipelli

What are "Social Determinants of Health?” Broadly speaking, social determinants of health are non-medical factors that can greatly affect a person’s health. These include economic policies and systems, development agendas, social norms, social policies and political systems.1 Vijay Nadipelli, Senior Director of Real World Evidence Partnership and Pipeline – Specialty, U.S. VEO at GSK, believes that these factors are critical in determining the health outcomes of people with lupus, but they are often overlooked in treatment plans. GSK is taking the lead in understanding how these social determinants of health can be identified and improve the health outcomes of those living with lupus.

Understanding Lupus

Lupus is a chronic disease that can flare and result in damage to vital organs, leading to hospitalization and other substantial personal and societal costs and burdens.14,15  Since organ damage can start to occur early on in the disease, it is important to be diagnosed early and start appropriate treatment as directed by your doctor.16 Crucial barriers to diagnosis and treatment factor into social determinants of health, and these should be addressed to promote the best outcomes for people living with lupus.

When a person living with lupus goes to the clinic and their doctor writes them a prescription that must be refilled regularly, how do they fill that prescription? Is there a pharmacy near the clinic or their home? Do they have access to transportation if the pharmacy is further away? If that person does not have access to a pharmacy, that prescription is not going to help them.

Source and Solutions for Health Inequities

Healthcare inequities can manifest from lack of access — like the pharmacy example above — that prevent marginalized groups of people from accessing the healthcare they need. Just as important, these populations also often lack the educational background and support to understand the healthcare associated with lupus,5,17–19 so they may not recognize the importance of the appropriate treatment to try and prevent organ damage, for example, and will thus delay treatment if the treatment seems to inconvenience them more than the disease symptoms at the time.

Health inequities result in as much as 30% of excess healthcare costs in marginalized groups of people20 because delays in diagnosis can result in unexpected medical visits which carry a financial burden.5,21,22 With lupus, a delayed diagnosis can lead to more frequent flares and repeat flares can lead to long-term damage to vital organs like the heart and kidneys.22,23 Thus, there is a critical need to screen and account for social determinants of health in treatment decision-making and overall healthcare considerations.

“It takes a village – the institution and everyone around the institution, i.e., the community, the payors, the policymakers and the patient organizations – to improve and establish equity in healthcare,” says Vijay. “That village is inclusive of the pharmaceutical industry. At GSK, we recognize that we develop the medicines, but we don’t stop there. We are collaborating closely with healthcare providers to properly evaluate patient care.”

GSK Leads the Way in Evaluating Social Determinants 

Our ultimate role as healthcare leaders is to help bring all of the people together who are needed to institute meaningful change.

GSK is proudly partnering with university centers of excellence in lupus care to identify the current effects of social determinants of health, as well as how those factors might be addressed. The contribution of patients is also invaluable. According to Vijay, “When you ask patients how they are doing in these aspects, it contextualizes their condition and empowers them to address social determinants of health.” Education in this regard is key. Nearly half of Americans are unaware of social determinants of health or how they are impacted by them.24

As leaders in this field, GSK aims to drive awareness of key messages in management of lupus. Patients and healthcare providers must recognize that as lupus is a chronic and progressive disease. Treating the symptoms is not enough, yet treating proactively requires consideration for more than just clinical aspects. GSK has always been at the forefront of driving patient-centric healthcare and we recognize that social factors and clinical factors are not isolated efforts to address. These are just the tip of the iceberg.

By connecting the entire village of patients, institutions, payors and biopharmaceutical companies, then evaluating both the necessities and feasibility of treatment plans in terms of social determinants of health, we take a comprehensive view of how to improve care for people living with lupus. This approach helps us fulfill GSK’s mission of empowering people to live their lives to the fullest. “We are trying to create a culture of a holistic care. We are trying to create a culture of health. And this is not just when someone falls ill in the hospital, it needs to be addressed much more up front, in everyday care.”


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