Creating a Culture of Holistic Care in Lupus

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.

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 of Health for Improving Outcomes

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.”

References

1. CDC. Social Determinants of Health. Centers for Disease Control and Prevention. Published December 8, 2022. Accessed October 16, 2023. https://www.cdc.gov/about/sdoh/index.html
2. U.S. Department of Health and Human Services. Social Determinants of Health - Healthy People 2030. health.gov. Accessed September 7, 2023. https://health.gov/healthypeople/priority-areas/social-determinants-health
3. U.S. Department of Health and Human Services. Health Care Access and Quality - Healthy People 2030 | health.gov. Accessed September 26, 2023. https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality
4. U.S. Department of Health and Human Services. Education Access and Quality - Healthy People 2030 | health.gov. Accessed September 26, 2023. https://health.gov/healthypeople/objectives-and-data/browse-objectives/education-access-and-quality
5. Hasan B, Fike A, Hasni S. Health disparities in systemic lupus erythematosus—a narrative review. Clin Rheumatol. 2022;41(11):3299-3311. doi:10.1007/s10067-022-06268-y
6. Brown EA, Gebregziabher M, Kamen DL, White BM, Williams EM. Examining Racial Differences in Access to Primary Care for People Living with Lupus: Use of Ambulatory Care Sensitive Conditions to Measure Access. Ethn Dis. 30(4):611-620. doi:10.18865/ed.30.4.611
7. American College of Rheumatology (ACR). Race, Ethnicity and Education Levels Linked to Longer Delays Accessing Lupus Specialty Care. Published November 9, 2016. Accessed October 16, 2023. https://www.newswise.com/articles/race-ethnicity-and-education-levels-linked-to-longer-delays-in-access-to-specialty-care-with-lupus
8. Centers for Disease Control and Prevention. National Lupus Public Health Agenda 2015.pdf. Published online 2015. Accessed October 17, 2023. https://www.lupus.org/s3fs-public/images/Advocacy/Documents/National%20Lupus%20Public%20Health%20Agenda.pdf
9. Michigan Medicine. Characterizing Diagnostic Delay in Systemic Lupus Erythematosus and Antiphospholipid Syndrome | Internal Medicine | Michigan Medicine. Internal Medicine. Published February 27, 2023. Accessed October 16, 2023. https://medicine.umich.edu/dept/intmed/characterizing-diagnostic-delay-systemic-lupus-erythematosus-antiphospholipid-syndrome
10. Buie J, McMillan E, Kirby J, et al. Disparities in Lupus and the Role of Social Determinants of Health: Current State of Knowledge and Directions for Future Research. ACR Open Rheumatol. 2023;5(9):454-464. doi:10.1002/acr2.11590
11. Starkman E. Lupus Epidemiology: Sex, Race, and Ethnicity. WebMD. Published March 4, 2022. Accessed October 16, 2023. https://www.webmd.com/lupus/lupus-epidemiology-sex-race-ethnicity
12. Lopez MA. Racial and Socioeconomic Disparities in Rheumatology - Rheumatology Advisor. Rheumatology Advisor. Published August 11, 2023. Accessed October 16, 2023. https://www.rheumatologyadvisor.com/home/topics/practice-management/resources-for-improvement-of-rheumatological-racial-and-socioeconomic-disparities/
13. Persaud N. Lupus Nephritis in SLE Hospitalizations More Likely Among Minority Groups. Rheumatology Advisor. Published December 13, 2021. Accessed July 5, 2023. https://www.rheumatologyadvisor.com/home/topics/systemic-lupus-erythematosus/sociodemographic-indicators-and-outcomes-of-lupus-nephritis-hospitalizations/
14. Barber MRW, Hanly JG, Su L, et al. Economic Evaluation of Damage Accrual in an International Systemic Lupus Erythematosus Inception Cohort Using a Multistate Model Approach. Arthritis Care Res. 2020;72(12):1800-1808. doi:10.1002/acr.24092
15. Ager M, Ji B, Perna A, Mosca M. Hospitalisation rates in systemic lupus erythematosus. In: 16th Congress of EAHP. Vol 16. ; 2011:OHP052. Accessed June 9, 2023. https://www.eahp.eu/sites/default/files/files/Vienna%20abstract%20book.pdf
16. Md Yusof MY, Vital EM. Early intervention in systemic lupus erythematosus: time for action to improve outcomes and health-care utilization. Rheumatol Adv Pract. 2021;6(1):rkab106. doi:10.1093/rap/rkab106
17. Demas KL, Costenbader KH. Disparities in lupus care and outcomes. Curr Opin Rheumatol. 2009;21(2):102-109. doi:10.1097/BOR.0b013e328323daad
18. Lupus Foundation of America. Health Disparities in Lupus - Advancing Health Equity in Lupus. Published 2023. Accessed July 5, 2023. https://www.lupus.org/health-disparities
19. Chapman M. Disparities in lupus care influenced by race, poverty, healthcare access | Lupus News Today. Published August 10, 2023. Accessed October 16, 2023. https://lupusnewstoday.com/news/disparities-lupus-care-influenced-race-poverty-healthcare-access/
20. Bernazzani S. The Importance of Considering the Social Determinants of Health. AJMC. Published May 1, 2016. Accessed July 5, 2023. https://www.ajmc.com/view/the-importance-of-considering-the-social-determinants-of-health
21. Feldman CH, Xu C, Williams J, Collins JE, Costenbader KH. Patterns and predictors of recurrent acute care use among Medicaid beneficiaries with systemic lupus erythematosus. Seminars in Arthritis and Rheumatism. 2020;50(6):1428-1436. doi:10.1016/j.semarthrit.2020.02.012
22. Kernder A, Richter JG, Fischer-Betz R, et al. Delayed diagnosis adversely affects outcome in systemic lupus erythematosus: Cross sectional analysis of the LuLa cohort. Lupus. 2021;30(3):431-438. doi:10.1177/0961203320983445
23. Thanou A, Jupe E, Purushothaman M, Niewold TB, Munroe ME. Clinical Disease Activity and Flare in SLE: Current Concepts and Novel Biomarkers. J Autoimmun. 2021;119:102615. doi:10.1016/j.jaut.2021.102615
24. Elevance Health. What’s Driving Our Health Study. www.elevancehealth.com. Published 2022. Accessed August 7, 2023. https://www.elevancehealth.com/research/social-drivers-of-health/whats-driving-our-health/whats-driving-our-health-findings